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Sharing perspectives leads to greater understanding and fuels innovation. The ​Optum Insights ​blog is where we share our perspective and challenge preconceptions to clear a new path forward



  • New WCRC, Capitol Bridge: Changes and trends

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    | May 15, 2019
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    WCRC, Medicare Insights
    Capitol Bridge, LLC assumed the reigns as the new Workers’ Compensation Review Contractor (WCRC) on 3/19/2018. Immediately following the transition to Capitol Bridge, it was noted that they have a different methodology for pricing. This has caused a slight increase in counter low/high determinations as the industry adjusts to the pricing methodology changes.


  • Don’t rely on an MSP Conditional Payment notice when executing a settlement agreement and general release

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    | May 15, 2019
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    Medicare Insights, Conditional Payment
    In a recent decision on 3/13/2018, Mayo v. NYU Langone Medical Center, the courts voided a settlement on the grounds of a mutual mistake because both the plaintiff and defense relied upon a conditional payment notice rather than a conditional payment demand or initial determination.


  • Frank Fairchok Rejoins Optum Settlement Solutions

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    | May 15, 2019
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    Medicare Insights
    Optum is pleased to announce that Frank Fairchok has recently rejoined the settlement solutions team as vice president of Medicare compliance reporting and development.


  • CMS Releases Update to WCMSA Reference Guide

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    | May 15, 2019
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    Medicare Insights, WCMSA
    The Centers for Medicare and Medicaid Services (CMS) released an update to their Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (version 2.7) with two changes.


  • Prescription drug updates may positively affect Medicare Set Aside

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    | May 15, 2019
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    Medicare Insights, Medicare Set-Aside
    As part of our best business practices, we continually monitor RED BOOK®Average Wholesale Price (AWP) of the most common medications present in Workers’ Compensation Medicare Set-Aside (WCMSA) arrangements. This practice assists in identifying price changes positively affecting WCMSAs.


  • WCRC contractor transition webinar held with The Centers for Medicare and Medicaid Services

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    • MSCC
    • Donna Mize
    | May 15, 2019
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    WCRC, Workers' Compensation, Medicare Insights
    The Centers for Medicare and Medicaid Services (CMS) held a webinar on March 7, 2018, to introduce Capitol Bridge, LLC, our new WCRC contractor, and review the transition plan. John Jenkins of CMS and Holly Havens of Capitol Bridge discussed the transition between the two WCRC contractors—the incumbent, Provider Resources, LLC, and Capitol Bridge. The last day for Provider Resources will be March 16, 2018, with Capitol Bridge beginning March 19, 2018. The transition will occur over the weekend and should not disrupt business or cause a backlog.


  • Important change regarding Medicaid secondary payer claim compliance

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    | May 15, 2019
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    Medicare Secondary Payer, Medicare Insights, Settlement Solutions
    On February 9, 2018 President Trump signed into law a new budget deal. The new law also contained an important change regarding Medicaid Secondary Payer compliance. What Optum had been anticipating Optum Settlement Solutions had been anticipating an Oct 1, 2017 effective date for state Medicaid agencies to begin enforcing the Medicaid Secondary Payer Act enacted in Section 202(b) of the Bipartisan Budget Agreement of 2013, referred to as the “Murray-Ryan bill”. The act permitted state Medicaid agencies to recover all payments Medicaid made related to the underlying personal injury claim before settlement. The recovery was to occur regardless of whether the damages/injuries claimed were related to the medical component of damages within a personal injury settlement or third party settlement.



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