Every allocation starts with the claim.
Every allocation begins with a genuine understanding of the individual claim in front of us, the injury, the treatment trajectory, the settlement posture, and the specific exposures that will shape the outcome. We work directly with you to identify cost-drivers early, resolve gaps and inconsistencies before they become obstacles, and build an allocation that is both defensible and calibrated to your settlement goals.
Each MSA is prepared by credentialed clinical professionals and priced with current, jurisdiction-appropriate methodology, so the number you carry into settlement negotiation is one you can stand behind.
Pre-MSA
The Pre-MSA is a focused, pre-settlement review designed to tell you where a claim stands before you commit to a full allocation. Rather than simply projecting a number, we examine the file for opportunities to mitigate exposure and pinpoint weaknesses in the settlement strategy where our guidance can strengthen your position. The result is a clear picture of what's driving cost and where there's room to move.
Every Pre-MSA comes with a roadmap to success, practical guidance on the additional information or clarification that would sharpen the analysis, and the medical case management steps that could be employed to position the file for a lower Medicare Set-Aside. When the time comes to convert the report into a traditional Medicare Set-Aside, you'll already know exactly what's needed to get there. It's a way to evaluate exposure early, address problems before they harden, and settle with confidence.
Workers' Compensation Medicare Set-Aside
Every Sparx Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) is built to CMS submission standards, structured and documented to withstand review whether or not the file is ultimately submitted for approval. We follow the WCMSA Reference Guide and current CMS policy on every allocation, from rated-age and life-expectancy analysis to the treatment projections and pricing that drive the final number, so nothing in the report invites a counter-higher determination that wasn't already anticipated and addressed.
The reports are grounded in the medical record. Our Clinical Specialists build each allocation from a careful analysis of the treatment history, tie every projected service to what the records actually support, and price it with current, jurisdiction-appropriate methodology. The result is a clear, fully documented report: an injury and treatment summary, a defensible projection of future Medicare-covered medical care, and a bottom-line figure you can carry into negotiation and defend with confidence.
Liability Medicare Set-Aside
CMS has no guidance for MSAs in liability settlements, nor does it offer approval similar to WCMSAs. Many question whether you even need an LMSA. But the MSP Act prohibits Medicare from making payments where there is another available payer, and any liability settlement that provided payment in exchange for a release from liability, whether admitted or not, for past and future medical expenses, makes the defendant a primary payer for MSP purposes.
Whether you called it a set-aside or not, some portion of your settlement is already an LMSA. The question is: if CMS enforces its secondary payer status post-settlement, who is going to decide how much of the settlement represented future medical? Wouldn't you rather defend your LMSA than risk CMS encumbering an unreasonable portion of the settlement as future medical that must be exhausted before Medicare becomes primary again?
Every Liability MSA is clinically grounded and built to withstand scrutiny from any party to the settlement. We draw on the WCMSA Reference Guide as a framework for sound methodology, while recognizing that liability settlements don't fit neatly within it, so we apply its principles where they make sense and rely on reasoned clinical judgment where they don't.
Our Clinical Specialists build each allocation from a careful analysis of the treatment history, tie every projected service to what the records actually support, and price it using usual-and-customary rates. The result is a clear, fully documented report: an injury and treatment summary, a defensible projection of future Medicare-covered medical care, and a bottom-line figure your parties can rely on and defend with confidence.
Often that evaluation doesn't work because the settlement is severely compromised by policy limits or negligence theories. At Sparx, we have legal professionals available to assist the parties in reaching an agreement on how to handle such an LMSA and make it work within your settlement.
Medical Cost Projection
A Medical Cost Projection (MCP) is a comprehensive forecast of a claimant's future medical care, all of it, not just the portion Medicare would cover. Where a Medicare Set-Aside isolates Medicare-covered services, an MCP captures the full picture: every anticipated treatment, procedure, medication, and service the injury is expected to require over the claimant's lifetime. It's the tool of choice when you need to understand true future exposure, for setting reserves, evaluating a claim, or negotiating settlement with the whole cost of care in view. An MCP is a settlement and reserving tool, not a trial or litigation document; it's built to inform your negotiations and financial planning, not to serve as evidence or expert testimony.
Each projection is built with the same care and clinical rigor as our Medicare Set-Asides. We work from a careful reading of the medical record, tie every projected service to what the treatment history actually supports, and price each line using the appropriate basis for the claim, fee schedule or usual-and-customary rates as the case requires. The result is a clear, fully documented projection you can rely on to see the complete financial scope of a claim and plan accordingly.
Surgical Cost Estimate
A Surgical Cost Estimate is a focused projection of the cost of a specific anticipated surgery, along with the post-surgical care expected to follow. Rather than forecasting a claimant's full course of future treatment, it zeroes in on a single procedure, capturing the surgery itself and the anticipated follow-up care for up to one year afterward, including the office visits, therapy, imaging, medications, and related services that typically accompany surgical recovery. It's the right tool when a known or recommended surgery is driving a claim and you need a clear, defensible figure for that exposure, whether you're setting reserves or working toward settlement.
Each estimate is built with the same care and clinical rigor as our other reports. We work from the medical record and the surgical recommendation, tie every projected service to what the treatment plan actually supports, and price each line using the appropriate basis for the claim, the workers' compensation fee schedule in states that have one, and usual-and-customary rates in states that don't. The result is a clear, fully documented estimate that isolates surgical exposure so you can reserve, evaluate, or negotiate around it with confidence.
Want to talk about a file? Refer a case.
Triage response within one business day.