J12 MAC Transition
(* = off-site link)
General
- How will I check the status of a CMS-855 Enrollment Form when Highmark Medicare Services (HMS) becomes the J12 MAC? Is there an online website available to verify the status of an enrollment application?
- We received a notice that the Recovery Audit Contractor (RAC) will be coming in January 2009. Will the RAC use the TrailBlazer E & M worksheet or Highmark Medicare Services E & M worksheet to conduct the audit?
- Will ERA files be transferred from TrailBlazer to Highmark Medicare Services
- Is Highmark Medicare Services looking to reduce the time it takes to enroll/credential providers?
- Will all enrollment forms currently being processed by TrailBlazer be sent to Highmark Medicare Services?
- Does Highmark Medicare Services have an office in Maryland?
- TrailBlazer is having problems with PIN/PTANs not being cross-walked to the NPI. Will this be resolved with the transition to Highmark Medicare Services?
- Is there a toll-free number for transition-related EDI questions?
- When will MD/DCMA/DE Part B providers receive their first payment from Highmark Medicare Services?
- Will I need to file a new CMS-855 Enrollment Form with Highmark Medicare Services when they become my Carrier or Fiscal Intermediary under MAC J12?
- Do I need to obtain a new PTAN/CCN or NPI Number from Highmark Medicare Services when they become the MAC contractor?
- Why do I need to fill out a new CMS-588 Form when I transition to Highmark Medicare Services?
- I have a Provider Enrollment application pending at the outgoing contactor and have not received a response. If I do not hear from them, should I send Highmark Medicare Services another application after the transition?
- Does Highmark Medicare Services anticipate any issues regarding the loading of the Medicare Fee Schedule on July 1, 2008 prior to cutover?
- Does Highmark Medicare Services anticipate any problems coordinating with commercial carriers for crossover purposes?
- If I use a third party vendor or clearinghouse that utilizes a logon, when the new logons are issued by Highmark Medicare Services, to whom will they be sent? The provider? The clearinghouse/vendor?
- Will PPTN ever be available?
- When should we stop sending enrollment applications to our current contractor?
- Will the LCDs be the same for Part A and Part B?
- When should we start sending IDEs to Highmark and to whom?
- When should we stop sending claims to our current contractor?
- Does HMS have the new P. O. Box numbers for transitioning providers?
- Will there be associated billing and coding articles with the LCDs?
- Will the local Medicare office and staff still be available after transition?
- What is the significance of the Operational Date?
- Will the District of Columbia Metropolitan Area (DCMA) Part B providers and workload be part of the J12 MAC transition?
- Will I continue using my current EDI Front-End Platform or connection method to submit electronic claims and retrieve electronic reports?
- What is Stratus? How do I connect to Stratus?
- If I submit a provider application now for a new provider number to my current contractor, what will happen if the process is not complete by the transition date when Highmark takes over?
- If I currently submit hardcopy claims, will Highmark Medicare Services allow me to continue to do so?
- Didn't CMS award the J12 MAC last October? Why is it taking so long for the workloads to transition?
- I submitted an EDI test and received the MCS Edit Report with testing results, and the report contained NPI errors. Is there something wrong with my NPI?
-
Highmark Medicare Services (HMS) does not provide status for Enrollment Applications via the web. We do, however, provide a toll-free Helpline at 1-866-488-0549 for provider enrollment assistance. Part A providers should choose Option 2; Part B providers should choose Option 1 when calling.
Please note that HMS does not possess information regarding any applications that are currently in process at an outgoing contractor until after the operational date for your specific state or locale. Once HMS is the J12 MAC for your specific state/locale, we will receive all pending workloads and begin to process the pending applications. Please do not call the toll-free number to inquire about the status of an enrollment form until after the operational date.
Date Posted: 06/19/2008
-
The Recovery Audit Contractor (RAC) would use the CMS guidelines and any information that was provided by the contractor where the claim was processed. Therefore, any instructions provided by Trailblazer would apply to claims that processed before the July 18, 2008 cutover date; claims processed on or after the July 18, 2008 date would be based upon information provided by Highmark Medicare Services. The Marshfield Clinic developed a worksheet that is used to help determine the appropriate level of E & M to be billed. Highmark Medicare Services currently has a copy of the worksheet on our website in the Physician/Provider area under the E&M section.
Date Posted: 06/02/2008, Date Reviewed/Revised: 06/12/2008
Will ERA files be transferred from TrailBlazer to Highmark Medicare Services
If you are currently setup to receive Electronic Remittance Advice (ERA) from TrailBlazer, you will also be setup to receive ERA from HMS.
TrailBlazer will create an ERA for you based on the claims that finalize processing at TrailBlazer on 07/10/08, and you will be required to retrieve the ERA (generated from the 07/10/08 cycle) from the TrailBlazer EDI Front-End Platform.HMS will generate the first ERA for you on 07/14/08 (for claims that finalize processing), and you will be required to retrieve the ERA (generated from the 07/14/08 cycle) from HMS. Please read the EDI Transition News for detailed ERA retrieval instructions and associated availability timeframes.
Date Posted: 06/03/2008
Is Highmark Medicare Services looking to reduce the time it takes to enroll/credential providers?
We are committed to processing Provider Enrollment initial applications and change requests within the performance parameters specified by CMS.
For initial CMS-855 applications, the standard is to complete 80% within 60 days while 80% of change and reassignment requests should be completed within 45 days.
It is expected we will inherit a large and aging inventory upon Cutover on July 11, 2008, from TrailBlazer. We have adjusted our staffing plan to address both the backlog as well as new receipts directed to our attention beginning July 11.
Date Posted: 06/02/2008
-
Yes, effective July 11, 2008, all enrollment forms in process, but not yet completed, will be transitioned to Highmark Medicare Services.
Date Posted: 06/02/2008
Does Highmark Medicare Services have an office in Maryland?
Yes, we currently have an office in Timonium. That office will be moving to Hunt Valley in early June. The office will primarily house claims, provider audit/settlement, and outreach and education staff.
Date Posted: 06/02/2008
-
This is an issue with all contractors, not just TrailBlazer. The nationally used cross-walk logic is being enhanced to help resolve this issue.
Date Posted: 06/02/2008
Is there a toll-free number for transition-related EDI questions?
Yes, 1-866-488-0546, option 3. We have dedicated EDI staff available to assist with EDI issues.
Date Posted: 06/02/2008
When will MD/DCMA/DE Part B providers receive their first payment from Highmark Medicare Services?
As part of the transition, TrailBlazer will utilize a 4 day pay forward “sweep” of the payment floor to release some claims in advance of their normal payment date. This will result in a larger payout than normal from their last production cycle on 7/11/2008. Highmark Medicare Services first production batch cycle will take place the evening of 7/14/08. However, we are not expecting to make our first payment until our production batch cycle taking place the evening of 7/17/08 and those payments should be date 7/21/08. This delay is due to added time necessary to modify the HIGLAS system as part of the transition and is the reason why we are employing a 4 day pay forward sweep of the payment floor.
Date Posted: 06/02/2008, Date Reviewed/Revised: 06/30/2008
-
No, providers/suppliers are not required to complete a new CMS-855 enrollment form due to the MAC J12 transition. Since CMS stores provider data in the national Provider Enrollment Chain Ownership System (PECOS), and Highmark Medicare Services will have access to that data at the time of transition, a new CMS-855 Form is not required.
Date Posted: 06/02/2008
-
No, Highmark Medicare Services will not be issuing a new CMS Certified Number (CCN) for Part A providers/suppliers or a new Provider Transaction Access Number (PTAN) for Part B as a result of the MAC J12 transition. You will continue to use your existing CCN/ PTAN for the IVR as you do today. In addition, your current National Provider Identifier (NPI) will continue to be valid for claim submissions to Highmark Medicare Services upon transition.
As new Part B providers enroll with Highmark Medicare Services, you may notice a difference in the numbering scheme for PTANs. Highmark Medicare Services uses a 6-digit provider number and then appends a three character suffix (alpha-numeric) for group members. All members of the group will have the same suffix. Since CCNs are issued by CMS for Part A providers/suppliers, there will be no change to that numbering scheme.
Date Posted: 06/02/2008
Why do I need to fill out a new CMS-588 Form when I transition to Highmark Medicare Services?
CMS requires each provider currently enrolled for Electronic Funds Transfer (EFT) with an outgoing contractor to complete a new EFT Agreement with Highmark Medicare Services using the standard CMS-588 Form. This is because the form is a legal agreement between you and the Medicare contractor which allows funds to be deposited into your bank account. A new agreement must be processed by the incoming contractor before any payments are issued. Failure to complete and submit a CMS-588 Form may result in a delay or interruption of your Medicare payments upon transition. You will receive a direct mailing from Highmark Medicare Services with a new CMS-588 form if you are currently a provider/supplier using the EFT service with an outgoing contractor.
As we process these forms, we will acknowledge via letter that the processing is complete. Should we have questions during processing, you may be contacted by phone to clarify information.
Date Posted: 06/02/2008
-
No, you should not send another application to Highmark Medicare Services if one is pending with the outgoing contractor. Highmark Medicare Services will receive all pending workload at transition. Duplicate applications will be returned.
Date Posted: 06/02/2008
-
No, Highmark Medicare Services does not anticipate issues regarding the loading of the Medicare Fee Schedule on July 1, 2008. This is normal business practice and not necessarily a transition activity.
Date Posted: 06/02/2008
-
The Coordination of Benefits Contractor, a CMS contractor, is responsible for maintaining crossover agreements with and distributing payment information to third party payers. CMS is working directly with the COBC to ensure changes are made to their system to support the uninterrupted transfer of payment information.
Date Posted: 06/02/2008
-
A new EDI Submitter ID and Login ID will be issued to the party that actually submits and manages claim billing. If you employ a billing service or clearinghouse to perform this function, those entities will receive this information.
This new Submitter ID and Login ID, along with a customer-controlled password, will be required to connect to your new EDI mailbox on Stratus, the Highmark Medicare Services’ EDI Front-End Platform.
Date Posted: 06/02/2008
-
The Professional Provider Terminal Network (PPTN), an online inquiry and eligibility product which TrailBlazer customers currently access via GP Online.net, is not available with Highmark Medicare Services. Highmark Medicare Services supports the CMS-preferred solution for the HIPAA 276/277 Batch Transaction process to provide Claim Status Inquiry and Responses. The Interactive Voice Response (IVR) is also to provide Claim Status Inquiry and Beneficiary Eligibility information. Paid and Pending Claim information may also be obtained via the Fax Back option listed on the IVR.
Date Posted: 06/02/2008
When should we stop sending enrollment applications to our current contractor?
Do not stop sending enrollment applications to your current contractor until the published cutover date for your locale.
Date Posted: 06/02/2008
Will the LCDs be the same for Part A and Part B?
The LCDs will be the same for Part A and Part B to the extent possible.
Date Posted: 06/02/2008
When should we start sending IDEs to Highmark and to whom?
You should begin submitting IDE requests to Highmark Medicare Services effective with your cutover date. IDE request should be sent to:
Office of the Contractor Medical Director
Highmark Medicare Services
1800 Center Street, 1A306
Camp Hill, PA 17089-0089
Attention: IDE ApplicationsDate Posted: 06/02/2008
When should we stop sending claims to our current contractor?
You should direct claims to your current contractor until one day prior to your cutover date.
Date Posted: 06/02/2008
Does HMS have the new P. O. Box numbers for transitioning providers?
Highmark Medicare Services will publish new post office box numbers for use in the J12 MAC in future segment-specific transition newsletters. These numbers are effective based on the operational start date for your respective state or locale. We anticipate publishing these new post office box numbers 30 days prior to each segment cutover. Effective with the date specified in future segment-specific transition newsletters for your state or locale, all Medicare documents must be mailed to the Highmark Medicare facility located in Camp Hill, Pennsylvania, using the specific post office boxes that will be provided as part of that segment implementation.
Date Posted: 06/02/2008
Will there be associated billing and coding articles with the LCDs?
Yes, LCDs will have associated billing and coding articles, where appropriate.
Date Posted: 06/02/2008
Will the local Medicare office and staff still be available after transition?
Highmark Medicare Service maintains offices in Fort Washington, Pittsburgh, Camp Hill, and Williamsport, Pennsylvania as well as Hunt Valley, Maryland. In accordance with the Centers for Medicare and Medicaid Services (CMS) requirements, Highmark Medicare Services maintains a Customer Contact Center to respond to provider inquiries. Provider Relations Research Specialists (PRRS) assist the Contact Center staff with more complex inquiries. In addition to the Contact Center, Provider Outreach and Education staff travel throughout the jurisdictional area and host provider workshops, seminars, webinars and teleconferences to ensure that providers have the most up to date Medicare information.
Date Posted: 05/07/2008
What is the significance of the Operational Date?
As of the Operational Date for your state, Highmark Medicare Services will be the Medicare Administrative Contractor (MAC). Regardless of date of service, all claims processing, customer service and claim payment functions will be performed by Highmark Medicare Services as of the Operational Date.
Date Posted: 05/07/2008
-
Yes, the DCMA Part B providers and workload, including the northern Virginia area, will be transitioned in its entirety to Highmark Medicare Services (HMS) as part of the J12 Medicare Administrative Contractor (MAC) workload implementation. The District of Columbia Metropolitan Area (DCMA) is defined as the District of Columbia, Prince Georges (MD) County, Montgomery (MD) County, Arlington (VA) County, Fairfax (VA) County, and the City of Alexandria (VA). The CMS Contracting Officer for the MAC J12 Contract has confirmed the DCMA transition and workload implementation plan as part of the Statement of Work. HMS is scheduled to commence the administration of the Part B Maryland, Delaware, and District of Columbia Metropolitan Area workload on July 11, 2008.
Date Posted: 05/07/2008
-
No, the Stratus Telecommunication Server is the EDI Front-End Platform at Highmark Medicare Services and will replace any existing EDI Front-End Platform you may currently use. You will, however, continue to bill electronically and retrieve your reports via your current front-end platform until notified of the date to transition to Stratus.
Date Posted: 05/07/2008
What is Stratus? How do I connect to Stratus?
The Stratus Telecommunication Server is the EDI Front-End Platform at Highmark Medicare Services. Stratus will replace any existing EDI Front-End Platform you may currently use.
Date Posted: 05/07/2008
-
All pending workloads, including any pending files/applications, will be transferred from your current contractor to Highmark Medicare Services in accordance with the approved implementation/cutover schedule (e.g., MD/DE/DCMA Part B workloads cutover to MAC on July 11, 2008). Processing of any pending applications will be completed by Highmark Medicare Services after the transfer of pending workload. Providers/suppliers should not send an additional copy of the application directly to Highmark Medicare Services. Duplicate applications will be rejected.
Date Posted: 05/07/2008, Date Reviewed/Revised: 05/21/2008
-
The guidelines for paper claim submission is the same for all contractors, including the MACs. Information on this Administrative Simplification Compliance Act (ASCA) can be found on CMS's website at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3440.pdf.
Date Posted: 05/07/2008, Date Reviewed/Revised: 05/28/2008
Didn't CMS award the J12 MAC last October? Why is it taking so long for the workloads to transition?
On October 25, 2007, CMS announced it had awarded Highmark Medicare Services the A/B MAC contract for J12. Shortly after the award announcement by CMS, Palmetto GBA (Palmetto) filed a protest with the General Accountability Office (GAO) of the award for J12. CMS notified GAO that the agency would be taking corrective action on certain aspects of the award decision. The result of this corrective action was that the original protest was dismissed by GAO. The agency has completed its corrective action and restored the contract award to Highmark Medicare Services. As a result, CMS authorized Highmark Medicare Services to resume work under J12. Highmark Medicare Services will assume full MAC responsibility for the J12 workloads by the end of 2008.
Date Posted: 05/07/2008
-
The purpose of conducting an EDI test in preparation for transition is to ensure that you can successfully connect to the Highmark Medicare Services' EDI Telecommunications Platform, transmit an EDI claim file, retrieve the 997 Functional Acknowledgement, and retrieve the MCS Edit Report. It is also an opportunity to view the new MCS Edit Report and learn how to read and interpret it. This is a very key component of your EDI Transition to Highmark Medicare Services.
If NPI errors are detected during this testing time period, please check the format and reporting of the NPI. If the correct NPI was reported in the proper format, the NPI error(s) may be as a result of the fact that the most current NPI crosswalk file is not available to Highmark Medicare Services for editing purposes as part of this EDI testing process. If you are reporting the same NPI on your production EDI files sent to your existing Medicare Contractor and are not receiving an error, then you should not receive an NPI error once you begin sending production files to Highmark Medicare Services after cutover.
Date Posted: 06/27/2008