Claims Solutions

Conditional Payment Dispute and Appeal Services

Mitigate liability and reduce costs with the expertise of our dedicated lien services team. Our specialists have extensive experience handling CMS conditional payments, Treasury claims, and Medicare Advantage and Part D recovery claims, ensuring effective management of Medicare liens.

Medicare conditional payment claims services

Insurers face significant liability and potential lawsuits for double damages by failing to reimburse Medicare's conditional payments. The rising number of Treasury claims and offsets highlights the need for proactive compliance. As an industry leader in Medicare compliance, we offer tailored lien solutions that ensure adherence to CMS requirements while maximizing savings across all lines of business.

A unique approach towards conditional payment claims

Our advocacy-driven approach to Medicare recovery claims helps you take control of the process to mitigate risk and reduce costs.

Advocacy and experience

Let our team help you navigate the tricky and nuanced Medicare recovery process to address and resolve conditional payment claims with confidence.

Reduce exposure and dispute unwarranted claims

Our lien services team has vast industry knowledge and experience in challenging CMS when appropriate to help you reduce exposure. We’re ready to dispute inappropriate and unrelated claims.

Proven results and savings

Our team advocates on your behalf to consistently deliver savings, minimizing risk and helping you settle more claims.

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Available On Demand - Medicare 2025 Watch List Webinar

Meeting the MSP Challenge

MSP compliance presents a unique set of challenges. Discover how setting a strong upfront strategy can help you succeed.

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Meeting the MSP Challenge

Over $350 million conditional payment program savings in reduced Medicare Liens between 2020 and 2022, and in 57% of cases reduced the lien to zero

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Feature and capabilities

Identify potential exposure

Let our team request and obtain Medicare’s claimed conditional payment amount.

Analyze Medicare’s conditional payment claim

Our team analyzes Medicare’s reimbursement claims to determine if filing a dispute is appropriate.

Dispute inappropriate or unrelated claims (when applicable)

We will dispute any date or service that is unrelated to the underlying claim or would otherwise not be owed by the insurance carrier.

Provide payment instructions (when applicable)

Upon resolution, we will provide detailed payment instructions for any dates of service for which reimbursement is owed, helping you resolve Medicare’s claim.

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Related resources

Learn about our unique approach to the conditional payment process that’s unparalleled in service, precision, and value.

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Only pay what you owe

Gain a strong advocate in Medicare disputes to eliminate risk and exposure.

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Meeting treasury claims and offsets

We have vast experience in dealing with Treasury claims and offsets. In addition, our G2G program can help you identify Treasury claims through a holistic compliance approach, achieving an average savings of 86% on Treasury requests.

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Navigate the complex world of MAPs

Let our experts continually monitor legal precedent in Medicare Advantage Plan cases to provide the most strategic path for your business.

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Stay ahead of changing Medicaid regulations

Protect your bottom line while staying compliant with Medicaid recovery changes. Automated compliance options are also available for Medi-Cal in California

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Do more with the Verisk ecosystem 

Our Conditional Payment Dispute and Appeal Services are part of our full suite of claims solutions that provide compliance, reporting, and decision support tools and services.

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Slash time and spend with AI-powered record review

Expedite record review with fast, accurate extraction of key medical information from unstructured documents. AI automation tools deliver accurate, impartial reviews of every file, helping you settle more claims while conserving time and resources.

Learn about Discovery Navigator

Conquer complex workers' compensation claims challenges

Streamline workers' comp data reporting and improve compliance with advanced analytics.

Learn about Workers' Comp State Reporting

Master workers' compensation data compliance reporting for insurers

Streamline and simplify workers' comp regulatory reporting with a single daily data feed. Insurers save time and improve accuracy with our suite of compliance reporting solutions.

Learn about wcPrism

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Identify severity faster with predictive analytics

Leverage AI and predictive analytics to quickly determine claim severity, improve triage, and control costs throughout the claims cycle.

Learn about wcNavigator

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Streamline Section 111 reporting

Proactively handle compliance and ensure error-free submissions to CMS with advanced analytical and smart reporting capabilities.

Learn about MSP Navigator

Comply with Medicare's requirements with confidence

Improve your Medicare compliance for future medical allocations while managing expenses with an advocacy-driven approach.

Learn about Medicare Set-Aside Allocation

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Build a cost-mitigation strategy

Leverage our industry-leading clinical and legal expertise to achieve MSA savings through experience, advocacy, and innovation.

Learn about Provider Outreach Cost Mitigation

Make Amended Review work for you

Maximize your one chance at obtaining an Amended Review from CMS—and gain savings for eligible claims.

Learn about MSA Second Look

Overcome MSP compliance limitations

Reduce risk and achieve full MSP compliance by streamlining payment process.

Learn about CP Link

Contact us to learn more

We are available Monday through Friday, 7 a.m. — 8 p.m. US Eastern Time:

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Note that password resets and user information are not available through Live Chat or Email. Instead, please call the main toll-free number below.

Main toll-free:

1-800-888-4476

Global toll-free:

International Access code, then 800 48977489
When calling from the UK, please dial 00 800 4897 7489

Refer a file

We offer easy access via our online form but can accommodate e-mail, fax, mail, or arrange a pickup from your office. Contact your local sales representative or e-mail us at referrals@verisk.com.

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