Project Medical
Service · Workers' Comp Medicare Set-Aside

The full WCMSA, in a maximum of seven business days.

Clinician-authored. CMS-submission ready. Add CMS submission filing or rush turnaround as the file requires.

What's in every WCMSA

Built against the CMS WCMSA Reference Guide.

Every report follows the same methodology, regardless of complexity. The case profile determines the depth of the review; the deliverable structure stays constant.

  • ICD-10–anchored diagnoses pulled from the medical record
  • Indexed treatment history with line-item citations
  • Projected treatment timeline over remaining life expectancy
  • Jurisdictional fee-schedule pricing on every line item
  • Rx allocation per the CMS WCMSA Reference Guide, with future-Rx priced at Red Book® AWP
  • Methodology appendix: cost basis, life-expectancy assumption, source citations
  • Delivered through the secure portal in standard CMS-ready format
Standards we don't negotiate on

Clinician-authored. In-house. Always.

Every WCMSA is read, analyzed, and authored in-house by a credentialed clinician on staff. The same author whose name and credentials appear on the report does the full review from intake through delivery.

Quality assurance

How we build a defensible MSA.

Every Medicare Set-Aside we prepare moves through a defined internal review before it reaches CMS. The goal is straightforward: no unsupported numbers, no avoidable counters, no surprises at submission.

01

Complete records review

We confirm the medical chronology covers the full treatment course relevant to the claim. Gaps are documented explicitly in the report.

02

Rated age verification

When a rated age is used, the source is verified against CMS standards. A single qualified rating is submitted directly; multiple ratings are handled under CMS's median rule with full disclosure, consistent with the current WCMSA Reference Guide.

03

Life expectancy

Life expectancy is calculated using the CMS-referenced life expectancy table in effect at the time of this report and references.

04

Allocation accuracy

Every line item is for a Medicare-covered service; non-covered care is excluded. Frequency and duration trace back to documented physician recommendations or standard of care. Surgical reserves reflect the probability language in the records.

05

Pricing integrity

All cost projections apply jurisdiction-specific pricing methodology, utilizing current CPT and HCPCS codes. Medication pricing is derived from Red Book® AWP and corresponds to the medications identified in the pharmacy summary or otherwise documented by the treating physician.

The result is an MSA that is internally consistent, fully sourced, and defensible on review.

Add-ons

Three add-ons available when the file warrants them.

01

CMS submission filing

We submit the WCMSA to CMS via the WCMSA Portal on your behalf and track the file through to final determination.

02

5-business-day rush

For files where the standard turnaround window is slightly too tight. Priced at intake.

03

3-business-day rush

For files with a hard near-term settlement or court deadline. Priced at intake.

The engagement, day by day

What happens between records intake and report delivery.

Day 0

Records received

Same-day acknowledgment. Engagement letter signed. Assignment to clinician.

Days 1–3

Authorship

Records reviewed. Diagnoses indexed. Treatment timeline projected. Fee-schedule pricing applied.

Days 4–5

Quality assurance

Internal review against the defined QA protocol. Methodology appendix finalized.

Days 6–7

Delivery

Report delivered through secure portal. CMS submission packaged where filing was added at intake.

Want to talk about a file? We respond within one business day.