This bulletin should be shared with all health care practitioners and managerial members of the provider/supplier staff.  Additional copies may be downloaded from our website at www.highmarkmedicareservices.com

Countdown has begun; do you have your NPI? Don’t risk disruption to your cash flow – Get your NPI now! National Provider Identifiers (NPIs) will be required on claims sent on or after May 23, 2007. Every healthcare provider needs to get an NPI! Learn more about NPI and how to apply by visiting www.cms.hhs.gov/NationalProvIdentStand/ on the CMS website.

This page also contains a section for Medicare Fee-For-Service (FFS) providers with helpful information on the Medicare NPI implementation.  A Countdown Clock is now available on this page to remind health care providers of the number of days left before the compliance date; bookmark this page as new information and resources will continue to be posted.

For more information on private industry NPI outreach, visit the Workgroup for Electronic Data Interchange (WEDI) NPI Outreach Initiative website at http://www.wedi.org/npioi/index.shtml on the web.

This notice is an update to PA Provider Notice 03-095 dated July 24, 2003.  There are additional instructions for providers to regarding ADR (Additional Development Request) letters.

Purpose
The purpose of this notice is to advise the provider community of the opportunity to update their MR (Medical Review) contact information in FISS and the importance of submitting accurate, complete and timely supporting documentation when responding to Additional Development Request(s) (ADRs).

Highmark Medicare Services is continually analyzing trends to find recurring, avoidable denials and developing training for the provider community that will aid in submitting claims properly. Highmark Medicare Services has seen a significant increase in the number of denials resulting from a lack of response to ADRs, missing documentation, incorrect provider mailing addresses in FISS, and multiple records of different beneficiaries submitted together with only one ADR letter attached.

In order to eliminate unnecessary denials, and save valuable time and resources, the following items should be remembered:

• When medical records are submitted, each medical record is to have a copy of the ADR letter for that beneficiary attached to the medical record submitted. Failure to do so may result in claim denials, misfiled records and delays in processing.
• Code claims correctly.
• When you receive an ADR, respond within 30 days to avoid denials.
• Use the ADR request letter as a guide when compiling the information for mailing.
• Thoroughly review the ADR to ensure that all items requested are submitted completely. The CMS
• Manual 100-04 Chapter 6 titled: SNF Inpatient Part A Billing is available if you need additional instruction in submitting bills for repetitive services. Keep ADR documentation separate for different service periods when multiple service periods are requested. 
• Attach ALL requested documentation for the service period requested to the original ADR letter.
• It is the responsibility of the provider submitting the claim for payment to obtain all the requested documentation, regardless of where the records are kept.
• Do not send part of the records while you are waiting for the rest. The first record submission received will be reviewed as the complete submission.
• Appeals and Benefit Integrity Units are separate from Medical review.  Records are not passed from one unit to another. 

The ADR and all requested documentation may be submitted by:

Changing the ADR Mailing Address
A Provider may contact Highmark Medicare Services directly to request that the MR Contact Information in FISS be updated. This request will apply only to the MR address field in the FISS provider file. To request this update the Provider should:

• Compose a letter on company letterhead asking that their mailing address/contact name be changed. This letter should:
  • include the Provider’s Name and Medicare ID number
  • list the address to which any MR mailings, ADR letter, etc. should be sent
  • name the title of the position to whose attention any mailings should be directed, i.e. Medicare Compliance Officer.
  • contain the signature an authorized employee/representative of the provider who is requesting the change
• Send the letter to:
  • Highmark Medicare Services
  • Attn. Matt McGinley
  • 120 Fifth Avenue Place, Suite P5301
  • Pittsburgh, PA 15222-0399

Please be advised that other requested changes to the FISS contact information must be submitted to CMS (Centers for Medicare Services) using their form 855-A. That form can be found on line which includes instructions for requesting such a change.

This is an LPET (Local Provider Education and Training) publication. You may contact Highmark Medicare Services with your clinical questions.  Please continue to check our website for informational bulletin, provider notices, and policy updates.

Provider Feedback Survey: 
Highmark Medicare Services LPET offers an easy method for providers to evaluate our training programs and materials and to make comments and suggestions for improving the educational process. Please take a few moments to complete the survey form.

References:
Provider Notice 03-095

Questions
If you have any questions regarding this bulletin, please contact the appropriate Customer Contact Center at:

Maryland Providers: 1-866-488-0545Pennsylvania Providers: 1-800-560-6170