J12 MAC Transition
(* = off-site link)

Medicare contractors may use discretion to establish medical policy, known as Local Coverage Determinations (LCDs), pertinent to their areas of jurisdiction.

As an integral component of the consolidation and transition of all Medicare Part A and Part B administrative functions for Jurisdiction 12, Highmark Medicare Services has proposed the following draft Local Coverage Determinations.  Jurisdiction 12 (J12) encompasses Pennsylvania, New Jersey, Delaware, Maryland, and the District of Columbia (which includes the northern counties of Virginia).   This initial draft set of LCDs was developed utilizing any and all LCDs currently in place in any of the states in J12 after a detailed analysis of the CERT, BESS, and HCIS data for all the J12 states.  In addition, input and feedback was solicited and obtained from Contractor Medical Directors from each of the states within the J12 region.

Although not a requirement for transition, Highmark Medicare Services is posting all draft LCDs for a 45 day comment period to obtain review and comment on the proposed draft LCDs prior to developing and publishing the final LCDs for Medicare Part A and Part B in J12. Comments will be accepted on all listed draft LCDs from April 1, 2008 through May 15, 2008. Comments can be submitted directly via our website at http://www.highmarkmedicareservices.com/transition/j12/lcd.html or by mailing any comments and supporting clinical literature/rationale to:

                        Andrew Bloschichak, MD, MBA
                        Vice President & Contractor Medical Director
                        Highmark Medicare Services
                        1800 Center Street, 1A306
                        Camp Hill, PA 17089

After review and consideration of all comments received by May 15, 2008, Highmark Medicare Services will incorporate valid comments to the proposed LCDs where clinically reasonable and supported by valid clinical evidence.  The final LCDs will then be posted to our J12 MAC website on or about May 23, 2008 at http://www.highmarkmedicareservices.com/transition/j12/index.html to provide at least 45 days of notice of the final LCDs prior to their implementation.

Highmark Medicare Services plans to fulfill CMS' requirement to consolidate LCDs by the first segment cutover, which is July 11, 2008  for the MD/DCMA/DE Part B workloads.  These consolidated LCDs, as well as any claim processing edits, will be effective for all of the other states when that locale cuts over to J12 MAC.  CMS has not finalized the implementation schedule for these other locales, but once finalized, Highmark Medicare Services will publish those cutover dates.   Until each locale's cutover date, any and all current legacy contractor LCDs and applicable claim processing edits remain in effect.

We look forward to working with the physicians, providers, and facilities as we transition and administer the Medicare Part A and Part B Program in J12.