Nobody Built an Integration for MSPRP. In 2026 the Agent Logs In and Pulls the Conditional Payment Letter Itself.

At 7:15 on a Tuesday, before the claims floor fills up, the Medicare compliance clerk at a regional property and casualty carrier already has nine tabs open. One is the Medicare Secondary Payer Recovery Portal. One is the Section 111 reporting site, where last quarter's claim input file kicked back four records for a date-of-incident mismatch. One is a state workers' compensation filing site that still asks the name of her first pet. The rest are county sheriff report sites, a salvage title screen that refuses an electronic power of attorney, and ISO ClaimSearch.

Not one of those places will send her anything. She has to go and get it, one login at a time. That is the job, and it is why the position exists.

Nine tabs is not a workflow problem, it is a no-front-door problem

Every carrier has a short list of systems that talk to each other: Guidewire ClaimCenter or Duck Creek on the inside, ImageRight beside it, a bill review vendor, maybe an estimating tool. Then there is the long list of screens that talk to nothing — run by CMS, by 50 state insurance departments, by county clerks, by police record resellers, by state DMVs. Those were built for a human with a browser and a password.

For years the answer was staffing. A carrier writing $300m to $600m in direct written premium usually has two to four people whose day is largely portal work: a Medicare compliance clerk, a claims support technician ordering police reports and title paperwork, a licensing coordinator in NIPR, and someone in compliance living in the state complaint systems and in SERFF around filing season. Nobody calls this a department. It just accretes.

Here is the plain definition worth quoting: computer use is an AI agent that works a website the way a claims clerk does — it opens the browser, signs in, clicks through the screens, reads what comes back and downloads the file — which means a carrier can finally automate a government portal that never offered any other way in.

The federal portal with a penalty clock attached

Of all the screens on that list, the Medicare ones carry the sharpest edge. Any carrier settling bodily injury, general liability or workers' compensation with a Medicare beneficiary is a responsible reporting entity under Section 111. You report the claim quarterly. Medicare comes back with conditional payments it says it made for treatment related to your loss: a Conditional Payment Letter, then a Notice, then a demand. You dispute the charges belonging to the claimant's diabetes rather than to the rear-end collision. Every step happens inside the Medicare Secondary Payer Recovery Portal, by hand.

The clock matters now in a way it did not five years ago. CMS's civil money penalty rule for late or wrong Section 111 reporting reaches records due on or after 11 October 2025, at up to $1,000 a day per claimant with an annual cap near $365,000 per claimant. And the boring version of the risk is worse than the dramatic one: nobody misses a report on purpose. They miss it because the clerk was out in the third quarter and the queue aged.

What changed in 2026: the agent drives the screen instead of waiting for a connection nobody offers

The 2024 version was a script that broke every time CMS moved a button. What shipped through 2025 and into 2026 differs in one way that matters to an operator: the agent looks at the screen, finds the field labelled "Case ID" wherever it sits today, and carries on. It also reads the letter it downloaded, so it knows whether it holds a Conditional Payment Letter or a demand with a 30-day response window.

Practically, you set it up the way you would onboard a temp: a named account with its own credentials and permissions, inside your network, with a recording of every click. Not the clerk's password on a sticky note. Any carrier under the New York Department of Financial Services Part 500 cybersecurity rule already has to evidence access control here, and a named agent account is easier to show an examiner than a shared login.

flowchart TD
  A["Recovery clerk opens the BI file in ClaimCenter"] --> B["Agent signs in to MSPRP under its own account"]
  B --> C["Agent pulls the Conditional Payment Letter and charge detail"]
  C --> D{"Any charge unrelated to the loss?"}
  D -->|Yes| E["Agent drafts the dispute packet with ICD codes cited"]
  E --> F["Clerk reviews, signs, uploads to MSPRP"]
  F --> C
  D -->|No| G["Agent files the letter in ImageRight, notes ClaimCenter"]
  G --> H["Adjuster sees the net Medicare demand on the reserve"]

A Tuesday in the recovery queue, the new way

The clerk's queue at 7:15 is no longer nine tabs. It is a list of 23 files the agent worked overnight, sorted by what it wants her to do. Eleven need nothing — the letter came back at zero, it is in ImageRight, the claim note is written and the reserve line is unchanged. Seven have a dispute packet already drafted: charge lines pulled from the payment summary, matched against the diagnosis codes on the medical records already in the file, with the unrelated lines highlighted and a short reason under each. She reads, adjusts two, signs, and the agent uploads them.

Five are stuck, and this is the part worth paying for. Two hit a portal error CMS has not fixed. One has a claimant whose Medicare status changed since the last quarterly report, so the reporting record needs correcting, not just the letter. Two carry amounts that disagree with what the adjuster reserved. The agent guessed on none of them. It stopped and said why.

The same account works the other screens on its off hours: ordering the crash report from the county reseller, checking the state workers' compensation site for acceptance of the subsequent report of injury, pulling the salvage title status on a total loss that has sat for eleven days. Dull, endlessly repeated errands that used to eat the middle of a claims technician's afternoon.

The arithmetic: 1,100 open files and a clerk-hour at $38

Assume 1,100 open bodily injury and workers' compensation files involving a Medicare-eligible claimant at any time. Assume six portal actions a year on each — an initial letter pull, two status checks, a dispute upload, a demand retrieval, a closing confirmation. Assume 11 minutes per action door to door: sign-in, multi-factor code, navigation, download, rename, upload to ImageRight, claim note. Loaded clerk cost $38 an hour.

Twenty-two thousand dollars does not buy a headline. It buys back most of a person, and the person is the point: she stops downloading files and starts arguing charges, which is the work that reduces what you actually pay Medicare. One avoided per-claimant penalty run pays for the whole thing several times over.

Where the agent must not click

It must not settle. It must not accept a demand amount, agree a repayment plan, or submit a final settlement detail document without a named human pressing the button. Write the rule into the procedure: the agent may read anything and prepare anything, but any action creating an obligation for the carrier needs a signature from someone with authority.

It must not invent a diagnosis link. When the agent drafts a dispute, it should quote the medical record page it pulled the code from and nothing else. If the file holds no record supporting the argument, the packet comes back short and the clerk chases the provider — same as always.

And it must not be trusted on the day a portal changes. CMS and the states redesign these screens with no notice to you. Expect a bad morning two or three times a year and keep the clerk's own login alive, so work does not stop while the agent is adjusted. Anyone promising zero-maintenance portal work has not sat through a Section 111 file rejection cycle.

Frequently asked questions

Is it acceptable to let software sign in to a CMS portal on our behalf?

Give the agent its own registered user under your reporting entity ID with the permissions that role needs, rather than borrowing a person's credentials. Keep the click log. When an examiner asks who pulled a letter on 4 March, you want a named account and a timestamped record — exactly what you cannot produce when three people share a login.

We are on Duck Creek, not Guidewire. Does that change anything?

Not much, because the hard part was never your core system. The agent's job is the outside screen. What differs is how the finished letter gets filed and how the claim note is written on your side, and both of those are configuration questions your existing administrator can answer in an afternoon.

What size carrier does this start to make sense for?

Roughly when you have one full-time person's worth of portal work — most carriers reach that around $150m to $200m in direct written premium, earlier if you write commercial auto or workers' compensation. Below that, the honest answer is your third-party administrator.

Could this replace our Medicare compliance vendor?

No, and be careful with anyone who says it can. Vendors carry judgment on set-aside allocations and take defined responsibility when they get it wrong. What the agent removes is the retrieval and filing labour vendors bill at a per-file rate, which is a reasonable negotiation to open at renewal.

The Monday version of this

Pick one portal, not nine — for most carriers the Medicare portal, because the queue is visible and the letters are dated. Have your clerk record every step for two days: which screens, which fields, what she does when the amount looks wrong. That recording is the whole configuration. Then run the agent read-only for two weeks, pulling and filing but never uploading, and compare its output to hers on the same files.

One last connection carriers forget: every letter the agent pulls generates a phone call — the claimant asking what the Medicare figure means, a paralegal chasing lien status, the body shop calling about a title. CallSphere builds AI voice and chat agents that answer those lines around the clock, take the claim number, capture what the caller wants and route or book it, so the quiet overnight portal work is not undone by a voicemail box nobody clears until Thursday.