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General
- 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?
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
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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
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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
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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.
Date Posted: 05/07/2008
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The guidelines for paper claim submission is the same for all contractors, including the MACs. If you have less than 10 full-time equivalent employees, you may submit paper claims. 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
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