2008 Medicare Participating Physicians Directory Now Available

The year 2008 Medicare Participating Physicians Directory (MEDPARD) is now available, via Internet only, here.  As in the past, hardcopies of the directory will not be distributed.

If you do not have access to the Internet at home, many local libraries and senior centers have computers available with Internet access.  Also, your local Social Security or Area Agency on Aging offices may be able to assist you as well.  As always, Highmark Medicare Services can assist you by calling 1-800-MEDICARE (1-800-633-4227), selecting option 3 and entering service code 00865.  A Highmark Medicare Services’ Customer Service Representative will provide you with information for participating doctors in your area.

To view the year 2008 MEDPARD on the Internet:

1. Enter here on your browser’s navigational window;
2. Click on the “People with Medicare” tab;
3. Click on “Find a Physician;”
4. Use the arrows/pull down windows to select a specific specialty in a specific county;
5. Click on the “Submit” button.  The doctor choices in your area will be displayed alphabetically.

When you contact a doctor’s office for an appointment, we recommend you ask whether or not the doctor is still a Medicare participating supplier.

2007 Medicare Participating Physicians Directory Now Available

The year 2007 Medicare Participating Physicians Directory (MEDPARD) is now available, via Internet only, at www.highmarkmedicareservices.com.  As in the past, hardcopies of the directory will not be distributed.

If you do not have access to the Internet at home, many local libraries and senior centers have computers available with Internet access.  Also, your local Social Security or Area Agency on Aging offices may be able to assist you as well.  As always, Highmark Medicare Services can assist you by calling 1-800-MEDICARE (1-800-633-4227), selecting option 3 and entering service code 00865.  A Highmark Medicare Services’ Customer Service Representative will provide you with information for participating doctors in your area.

To view the year 2007 MEDPARD on the Internet:

1. Enter http://www.highmarkmedicareservices.com on your browser’s navigational window;
2. Click on the “People with Medicare” tab;
3. Click on “Find a Physician;”
4. Use the arrows/pull down windows to select a specific specialty in a specific county;
5. Click on the “Submit” button.  The doctor choices in your area will be displayed alphabetically.

When you contact a doctor’s office for an appointment, we recommend you ask whether or not the doctor is still a Medicare participating supplier.

New Medicare Summary Notice (MSN) Mailing Schedule

Effective June 1, 2006, the Centers for Medicare & Medicaid Services (CMS) implemented a new Medicare Summary Notice (MSN) mailing schedule. If you are not due a payment check for assigned claims from Medicare, your MSN will now be mailed to you on a quarterly basis. You will no longer receive a monthly statement in the mail for these types of MSNs. You will now receive a statement every 90 days summarizing all of your Medicare claims. If you receive a bill from your provider before you receive an MSN, you can request an individual MSN for each claim affected. We cannot issue a monthly or quarterly summary if the request is before the scheduled release date of the MSN. Please call the Customer Contact Center at 1-800-MEDICARE (1-800-633-4227).

First Coast Service Options, Inc. Begins QIC Part B North Operations Effective November 15, 2006

As you are aware, a separate contractor called a Qualified Independent Contractor, or “QIC” handles second level appeals, termed “reconsiderations”.  Beginning November 6^th, 2006, all redetermination letters, which communicate the results of the first level of appeal, will include instructions on how to request a reconsideration to the new QIC contractor, First Coast Service Options, Inc. (FCSO).

First Coast Service Options, Inc. Begins QIC Part B North Operations Effective November 15, 2006

As you are aware, a separate contractor called a Qualified Independent Contractor, or “QIC” handles second level appeals, termed “reconsiderations”.  Beginning November 6^th, 2006, all redetermination letters, which communicate the results of the first level of appeal, will include instructions on how to request a reconsideration to the new QIC contractor, First Coast Service Options, Inc. (FCSO).

FSCO will begin processing these reconsiderations on November 15, 2006 for the North jurisdiction, which includes:  Alaska, Maine, Vermont, New Hampshire, Massachusetts, Road Island, District of Columbia, New York, Pennsylvania, New Jersey, Delaware, Maryland, Ohio, Kentucky, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Missouri, Iowa, Washington, Oregon, California, Nevada, Arizona, Utah, Hawaii, Guam, Northern Mariana Islands, and American Samoa.  The address to send the QIC reconsiderations to will be:

First Coast Service Options, Inc.
QIC Part B North Reconsiderations
P.O. Box 45208
Jacksonville, FL 32232-5208

Any additional documentation, new information or medical evidence that may assist the QIC in reevaluating the claim(s) should be attached to the written reconsideration request.  If no additional information is submitted, a decision will be made based on the documentation contained in the AC’s redetermination case file.

NOTE:  To aid in the processing of your request and to avoid significant delays, a copy of the redetermination letter should accompany your reconsideration request.

Suppress Medicare Summary Notices when no beneficiary responsibility

Effective August 18, 2006, Highmark Medicare Services began suppressing Medicare Summary Notices(MSN) for Pennsylvania beneficiaries when they have no responsibility because the services were denied and you are not liable, the services were paid in full or you have supplemental insurance coverage that may pay the existing balance. It is important to note that the MSN will still be sent to your supplemental insurance company. Highmark Medicare Services will not suppress the MSN if the claim contains a denied service(s) for which you are liable or if you still owe your deductible. In addition, you can request a copy of the MSN by calling 1-800-Medicare (1-800-633-4227).

MSN Quarterly Mailing

Effective June 1, 2006, if you are not due a payment check for assigned claims from Medicare, your Medicare Summary Notices (MSN) will now be mailed to you on a quarterly basis. You will no longer receive a monthly statement in the mail for these types of MSNs. You may receive a bill from your provider before you receive an MSN. When you receive the MSN be sure to compare with any bill you may have received from the provider.