J12 MAC Transition
(* = off-site link)

Riverbend GBA (Riverbend) and Highmark Medicare Services (HMS) wish to remind all providers that it is the intent of CMS, Highmark Medicare Services, and Riverbend for the transition from the current Fiscal Intermediary to the Medicare Administrative Contractor (MAC) to be as seamless as possible to providers.   The key to accomplishing this is the issuance of timely and direct communications by the MAC and an affirmative and timely response by those that need to react to changes due to the transition.  Several inquiries have been received relative to certain billing and connectivity issues. A preliminary assessment of the claim processing environment indicates that the transition to HMS will involve:

• Connecting to a new platform and learning new EDI report retrieval methods, etc. for electronic data interchange (EDI) billing.  For EDI billers, Highmark Medicare Services provides direct connectivity to the EDI Platform for no fee.  Providers, however, are responsible for normal fees associated to billing software/services and telephone charges. 
• Contracting with a Third-Party Secure Direct Data Entry (DDE) Vendor for DDE access (for claim entry, error correction, beneficiary eligibility, and claim status).  Only those providers who contract with a Third-Party Secure DDE Vendor will be able to connect to FISS for DDE. 

Preparations for the New Jersey Part A workload transition will be made over the four month period from May through August, 2008. Intensive, targeted education and information will be provided to you during this period of time.  HMS is cognizant of the need for ample lead time with respect to both EDI and DDE functions and will act accordingly to inform all affected parties in a timely manner.

Providers are advised NOT to make decisions about software, contracts, services, and consulting related to the transition until full information has been provided by HMS and Riverbend.  Additionally, Riverbend will be happy to investigate specific institutional concerns prior to the start of the New Jersey Part A segment.  HMS will start intensive education and outreach effort as soon as the segment transition officially opens and allows them to do so. 

An advance article prepared by HMS regarding the need to contract with a Third-Party Secure DDE Vendor to continue DDE upon transition to HMS is included below for your planning purposes. 

“Part A Providers Must Contract With a Third-Party Secure DDE Vendor to Use DDE Upon Transition to Highmark Medicare Services

Virtually all Part A providers access FISS, the Medicare Part A processing system, for the purpose of Direct Data Entry (DDE) to verify beneficiary eligibility, enter claims directly into the FISS Medicare processing system, verify claim status, and/or perform claims correction, so you will need to take immediate action when the transition to Highmark Medicare Services begins to avoid billing and payment delays. 

All Part A customers accessing FISS for DDE (to verify beneficiary eligibility, enter claims directly into the FISS Medicare processing system, verify claim status, and/or perform claims correction) must contract with one of the Secure Third-Party DDE Vendors in order to continue using DDE.  Once the transition to Highmark Medicare Services begins, you will need to contact a Secure Third-Party DDE Vendor immediately to initiate the contract and setup arrangements.  You may even want to start contacting Secure Third-Party DDE Vendors now to begin the research and selection process.  A list of Secure DDE Vendors is available on our Part A website.

Many customers are migrating at once, so it is important for you to take action as soon as the transition to Highmark Medicare Services begins to avoid any interruption in your DDE capabilities.  If you do not make this change prior to the transition deadline, which will be published at a later date, you will not be able to enter claims in FISS, perform claim corrections, verify beneficiary eligibility, or check claim status via DDE.” 

Please be sure to visit the HMS website for important transition information and to become a member of the HMS listserv to receive timely transition updates and alerts.