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J13 Transition Frequently Asked Questions
Q1. Where
will National Government Services be located?
Q2. What
is meant by the “Cutover Date”?
Q3. If I
submit a provider application for a new provider number to my current
contractor, what will happen if the process is not complete by the transition
date when National Government Services takes over?
Q4. I am
in a small practice and I currently submit hardcopy paper claims. Can I
continue to do so after the cutover date?
Q5. We
currently submit claims electronically directly to the current Medicare
contractor. We do not use a clearinghouse. Will we continue to use the current
dial in for EDI to submit claims and download electronic reports?
Q6.
Should I continue to follow the legacy carrier’s local coverage determination
(LCD) until the cut over date?
Q7. We
are a nonparticipating provider, currently our patients pay us up front and our
carrier reimburses the patient, will this change when we transition?
Q8.
After the transition occurs will I have to call a different telephone number in
order to reach the IVR (Interactive Voice Recognition) System?
Q9. When
the transition has been completed what fee schedule should I be referring to?
Q10.
Are there plans to implement a crosswalk from old legacy policies to the new J13
policies?
Q11. If
I have submitted a CMS-855 application prior to the cut over date and it has
not been completed prior to the transition will I be
able to check the status with the new J13 customer care representatives?
Q12. If
we currently receive our payments electronically through our legacy carrier
will we have to do anything to ensure the same payment method with National
Government Services after our cut over date?
Q13. If
our providers have worked with the legacy carrier medical directors to gain
preapproval for investigational devices or off labeled-drugs will those
approvals be carried over to claims processing within
National Government Services?
Q14.
What address do I mail my new Electronic Funds Transfer (EFT) Agreement at
National Government Services?
Q15. Do
I need to sign a new EDI trading partner agreement for the MAC contractor?
Q16.
What address do we mail the new EDI agreements for a
submitter ID applications?
Q17.
What does change in EDI connectivity mean?
Q18.
Will I still be able to receive eligibility information from IVANS.
Q19.
Will I still be able to use Medicare Remittance Easy Print (MREP)?
Q20.
How are you currently working with Clearinghouses to make sure this is a smooth
transition?
Q21.
When we send in a new Electronic Fund Transfer (EFT) application indicating NGS
on the CMS 588 form, we do not receive a confirmation of receipt. How can we
find out if the application was received?
Q22.
Who can sign the EFT application?
Q23. I
have an EFT application on file with NGS and GHI, do I need to do anything?
Q24. If
we do not file a new EFT application can we revert back to a paper check?
Q25.
GHI currently offers PC-ACE software. Will the hyper terminal still work?
Q26.
Can we continue to use the PC-ACE software?
Q27. I
currently use Medicare Claims Express for Health Now,
will this change.
Q28. I
signed up for the listserv, when can I expect to start receiving notices?
Q29. Am
I correct in understanding that if I am a Connecticut provider that as of
August 1, 2008 I will then need to submit to National Government Services (NGS).
Q30. If
I choose to Early Board my electronic claims, from which contractor will I receive my electronic
remittances (ERA)?
Q31.
Will we be able to receive the remittances from both NGS and GHI?
Q32.
Will these scheduled J13 calls be repetitive or do I need to listen into every
call?
Q33. In
regard to the Local Coverage Determinations (LCD), the effective date of these
policies are the date of services equaling the cutover date (e.g. For
Connecticut providers the date is 08/01/2008). If I submit a claim a few days
prior to the cutover and it is not processed at the current contractor before
the cutover date, what policy will apply?
Q34.
NGS (Legacy Empire) is my Part B contractor and I already bill NGS. What
changes will affect?
Q35.
Will there be additional staff added to the customer services lines?
Q36. Is
there an issue with providers having two separate PTAN’s?
Q37.
Are the mailing addresses going to change?
Q38. I
am a Part A provider for CT and NY what do I need to do since we are already
part of NGS?
Q1. Where will National Government
Services be located?
A1. National Government Services
is headquartered in Indianapolis, IN and will maintain offices
in:
- Louisville, KY
- Harrisburg, PA
- Syracuse, NY
- Middletown, CT
- Binghamton, NY
- Westchester, NY
In accordance with the Centers for Medicare &
Medicaid Services (CMS) requirements, National
Government Services maintains a Customer Care contact center to respond to provider
inquiries as well as the Interactive Voice Response (IVR) system. Provider Relations
Research Specialists (PRRS) are located with the Customer Contact Center and can assist with more
complex inquiries. Our provider outreach and education (POE) staff will travel throughout
our jurisdiction and will conduct provider training sessions, workshops, seminars,
Webinars, and teleconferences to provide our providers with the most up to date
Medicare information available.
Updated: 06/24/2008
[Back to top]
Q2. What is meant by the “Cutover
Date”?
A2. Based on our implementation
schedule, National Government Services will take over the work of the outgoing Medicare
contractor on a specific cutover date. On that cutover date, National Government
Services will be the Part A/Part B Medicare Administrative Contractor (MAC) for Connecticut and New York. It is important to note
that outgoing Medicare contractors will transfer all pending and in-process operations
to the NGS J13 A/B MAC on the cutover date listed
above. Regardless of the date of service, the NGS J13 A/B MAC will handle provider claims
processing, enrollment agreements, customer service, and payments on these cutover
dates.
Updated: 06/24/2008
[Back to top]
Q3. If I submit a provider
application for a new provider number to my current contractor, what will happen
if the process is not complete by the transition date when National Government Services
takes over?
A3. All pending workloads,
including any provider enrollment agreements will be transferred from the current
contractor to National Government Services on the cutover date. National Government
Services will complete the pending agreements soon after cutover.
Updated: 06/24/2008
[Back to top]
Q4. I am in a small practice
and I currently submit hardcopy paper claims. Can I continue to do so after the
cutover date?
A4. The Administrative Simplification
Compliance Act (ASCA) guidelines for paper claim
submission states if you have less than ten (10) full-time equivalent employees
(FTEs), you may submit paper claims. Detailed instructions for completing the CMS-1500 claim form can be
found on our Web site at http://www.ngsmedicare.com/ngsmedicare/PartB/EducationandSupport/ToolsandMaterials/CMS_ClaimFormInst.aspx
Information on the ASCA can be found on CMS’s Web site at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3440.pdf.
Updated: 06/24/2008 [Back to top]
Q5. We currently submit claims
electronically directly to the current Medicare contractor. We do not use a clearinghouse.
Will we continue to use the current dial in for EDI to submit claims and download
electronic reports?
A5. It is important to note
there are two (2) answers to this question, one for providers currently served by
HealthNow Medicare and another for providers served by GHI Medicare and FCSO.
GHI and FCSO Providers:
YOU MUST TAKE ACTION PRIOR TO CUTOVER! National Government Services uses the M2
Translator as the EDI front-end platform will replace any existing EDI front-end
platform which you currently use. Some things to keep in mind:
- Electronic
Trading Partners/Electronic Submitters DO NOT need to re-enroll with National
Government Services EDI. A new agreement is not necessary for existing electronic
submitters.
- National
Government Services is assigning all current GHI and FCSO Electronic Trading
Partners/Electronic submitters a new submitter IDs and passwords. This
information will be sent via mail directly to all GHI/FCSO submitters.
- Electronic
Trading Partners/Electronic Submitters need to connect to National Government
Services M2 Gateway:
- ASYNCH
Dial-UP supports z-modem protocol only: number provided with new submitter
ID. National Government Services provides dial-up connectivity via ASYNC or
FTP. The Dial-Up Asynchronous Communication Manual and the DIAL
UP FTP Manual
for configuring your telecommunications software can be found on the J13 Web
site at: http://www.ngsmedicare.com/ngsmedicare/PartB/J13/edisystems.aspx
- Dial-UP
FTP: number provided with new submitter ID. See Dial-up FTP guide on the J13
Web site at: http://www.ngsmedicare.com/ngsmedicare/PartB/J13/edisystems.aspx.
Network Service Vendors are available:
ECC Technologies
Web site: www.ecctec.com
Customer Service: 585-377-1850
IVANS
Web site: www.ivans.com
Customer Service: 800-548-2675
Nebo Systems, Inc.
Web site: www.nebo.com
Customer Service: 630-916-8818 extension 261
VisionShare
Web site: www.visionshareinc.com
Customer Service: 612-460-4327
MedXPress
Web site: http://www.icssoftware.net/MedXpress
Customer Service: 877-624-3250
Once GHI and FCSO electronic submitters have migrated to the National Government
Services M2 Front-end platform, you will begin to receive the National Government
Services EDI acknowledgement transactions and reports:
- TA1
acknowledgment transaction
- 997
acknowledgment transaction
- TRN acknowledgment report
- National
Government Services Claims Correction Report; also referred to as GenResponse
Report
- MCS EMC Input Batch Reject Listing (CMS Part B Implementation Guide and
business edit reporting)
The cut-off time for National Government Services
receipt of your electronic files is 4:00 p.m. Eastern Time (ET).
- TA1,
997, TRN, National Government Services Claims Correct Report are
returned to the submitter the same day as transmission of the file.
- MCS EMC Input Batch Reject Report available
for retrieval the next business day.
HealthNow Providers:
HealthNow will continue to serve as the EDI Gateway into National Government Services
Medicare. The current HealthNow EDI gateway will continue to accept inbound files
that will be sent from HealthNow to National Government Services for processing
through our M2 translator. Once the electronic files are processed through the National
Government Services front end, electronic reports and Electronic Remittance Advice
(ERA) will be returned from National GovernmentServices to HealthNow. HealthNow
will populate the reports and ERAs in the current HealthNow electronic mailboxes.
As of the cutover date of September 1, 2008, there is one change you
must make to your claim files. The new NGS J13 A/B MAC contractor number, 13282,
must be populated in your claim transactions in the ISA08 field. The following
data elements in the 837 claims transaction must be updated with these identifiers:
You may need to contact your vendor for assistance in updating this information
in your billing software.
- HealthNow
Current contractor number: 00801
J13 contractor number: 13282
Note: see Claims Confirmation Report detail for
edits related to these data elements.
Updated: 06/24/2008 [Back to top]
Q6. Should I continue to follow
the legacy carrier’s local coverage determination (LCD) until the cut over date?
A6. Yes, the J13 LCDs will
not go into effect for your jurisdiction until we have reached the cut over date,
after that point you will follow the J13 LCDs you see on the Web site.
Updated: 06/24/2008 [Back to top]
Q7. We are a nonparticipating
provider, currently our patients pay us up front and our carrier reimburses the
patient, will this change when we transition?
A7. No, this is a condition
based upon your participation status, therefore as long as you remain a nonparticipating
provider you will continue to do business as usual.
Updated: 06/24/2008 [Back to top]
Q8. After the transition occurs
will I have to call a different telephone number in order to reach the IVR (Interactive
Voice Recognition) System?
A8. No, the number you currently
use to reach the IVR will remain the same, however there
will be a new number for you to utilize when contacting the customer care area.
We will publish a new telephone number for the Customer Care Contact center approximately
two (2) weeks prior to cutover.
Updated: 06/24/2008
[Back to top]
Q9. When the transition has
been completed what fee schedule should I be referring to?
A9. The transition of the J13
A/B MAC does not change your fee schedule, your fees will
still be determined in the same manner they are now based on geographical area,
Relative Value Units, etc.
Updated: 06/24/2008 [Back to top]
Q10. Are there plans to implement
a crosswalk from old legacy policies to the new J13 policies?
A10. Yes we will post the LCD
crosswalk on the J13 section of our Web site, this will allow you to view the legacy
vs. the new J13 polices, you will also be able to comment on the new policies as
well.
Updated: 06/24/2008[Back to top]
Q11. If I have submitted a CMS-855 application prior to
the cut over date and it has not been completed prior to the transition will I be able to check the status with the new J13 customer care representatives?
A11. Yes, as of the cut over
date you will be calling a different area however the representatives will have
access to your pending enrollment status. We will publish a new telephone number
for the Customer Care Contact center approximately two (2) weeks prior to cutover.
Updated: 06/24/2008 [Back to top]
Q12. If we currently receive
our payments electronically through our legacy carrier will we have to do anything
to ensure the same payment method with National Government Services after our cut
over date?
A12. Yes, prior to the cut
over date you will have to complete a new Electronic Funds Transfer Agreement with
National Government Services. We will be mailing the agreement to you, it is expected
that you fill it out promptly to ensure a smooth transition. Your current agreement
is a contract between you, your bank and your legacy Medicare carrier, the agreement
must be updated to reflect National Government Services. If we do not receive your
EFT agreement in a timely manner, your Medicare payments may be delayed or disrupted.
Updated: 06/24/2008 [Back to top]
Q13. If our providers have
worked with the legacy carrier medical directors to gain preapproval for investigational
devices or off labeled-drugs will those approvals be carried
over to claims processing within National Government Services?
A13. Those agreements would very likely be
automatically carried over, however we will make available to you the email
addresses of our carrier medical directors so that you may work with them in
addressing your unique situations.
Updated: 06/24/2008 [Back to top]
Q14. What address do I mail my
new Electronic Funds Transfer (EFT) Agreement at National Government Services?
A14. The EFT agreement should
be mailed to:
National Government Services, Inc.
Part B Provider Enrollment
P.O. Box 4792
Syracuse, NY13221-4792
Updated: 06/24/2008 [Back to top]
Q15. Do I need to sign a
new EDI trading partner agreement for the MAC contractor?
A15. No, your current
agreement will remain in effect. However, If a
provider is becoming an electronic submitter, than a new EDI agreement is
need. Please visit our website at http://www.NGSMedicare.com/ngsmedicare/CarrierInquiry_Enrol.aspx
Updated: 07/10/08 [Back to top]
Q16. What address do we mail the new EDI agreements
for a submitter ID applications?
A16. This can be completed online, Please visit our website at http://www.NGSMedicare.com/ngsmedicare/CarrierInquiry_Enrol.aspx
Updated: 07/10/08 [Back to top]
Q17. What does change in EDI connectivity mean?
A17. A change in
connectivity is making a change in the way in which you send your electronic
claim file to the contractor. Refer to
question # 5 for further clarification.
Updated: 07/10/08 [Back to top]
Q18. Will I still be able
to receive eligibility information from IVANS.
A18. Yes.
Updated: 07/10/08 [Back to top]
Q19. Will I still be able
to use Medicare Remittance Easy Print (MREP)?
A19. Yes, this is a CMS software and it will
not be impacted by the transition.
Updated: 07/10/08 [Back to top]
Q20. How are you currently
working with Clearinghouses to make sure this is a smooth transition?
A20. We are working with
the practice management software vendors and claims clearinghouses to make sure
they are prepared for the transition.
However, we advise all providers to contact the vendor or clearinghouse
to make sure they will be ready at the cutover.
Updated: 07/10/08 [Back to top]
Q21. When we send in a new
Electronic Fund Transfer (EFT) application indicating NGS on the CMS 588 form, we do not
receive a confirmation of receipt. How can we find out if the application was
received?
A21. Contact our Customer CareCenter at 866-837-0241 and we will confirm
receipt of EFT applications. Please have your practice name and provider number
available when calling.
Updated: 07/10/08 [Back to top]
Q22. Who can sign the EFT
application?
A22. Only an authorized or
a delegate officer on the 855 application form can you can sign the EFT
application.
Updated: 07/10/08 [Back to top]
Q23. I have an EFT
application on file with NGS and GHI, do I need to do anything?
A23. Yes, your application
on file with NGS will not change. However, your original application on file
with GHI is an agreement between you, your bank and GHI. A new application will
need to be submitted so the new agreement will be with NGS, you and your bank.
Updated: 07/10/08 [Back to top]
Q24. If we do not file a
new EFT application can we revert back to a paper check?
A24. No, the law states
that we can not do this. If you do not complete the new Application, your
payments may be delayed or interrupted.
Updated: 07/10/08 [Back to top]
Q25. GHI currently offers PC-ACE software. Will
the hyper terminal still work?
A25. Yes.
Updated: 07/10/08 [Back to top]
Q26. Can we continue to
use the PC-ACE software?
A26. GHI and FCSO
providers that currently use the PCACE software provided by GHI or FCSO, will need to upgrade to the NGS version of the PCACE
software. The National Government
Services version of the PC ACE Pro32 claim submission software for GHI and FCSO
electronic submitters is now available.
If you currently utilize the PC ACE billing software that was supplied
to you from either GHI or FCSO only, you will need to obtain the new version of
PCACE. The new software is available for
download from the J13 web site: http://www.ngsmedicare.com/ngsmedicare/PartB/Claims/EDI/Software/pcace_j13.asp
Updated: 07/10/08 [Back to top]
Q27. I currently use
Medicare Claims Express for Health Now, will this
change.
A27. You can continue to
use Medicare Claims Express for your Health Now submissions.
Updated: 07/10/08 [Back to top]
Q28. I signed up for the
listserv, when can I expect to start receiving notices?
A28. Once the provider
registers for the Listserv, they will receive an email requesting their
confirmation of the registration. The provider must respond to this e-mail
request in order to begin receiving Listserv mail messages. Once this process
is completed, the provider should begin receiving messages within the next day
or two.
Updated: 07/10/08 [Back to top]
Q29. Am I correct in
understanding that if I am a Connecticut provider that as of August 1, 2008 I will then need to
submit to National Government Services (NGS).
A29. Yes. If you are an
electronic submitter, you may begin to submit your electronic claims before the
August 1, 2008 cutover date, if you
elect to Early Board with NGS. For more
information about early boarding, visit our website at http://www.ngsmedicare.com/ngsmedicare/PartB/J13/earlyboardingofm2connectivity.aspx
Updated: 07/10/08 [Back to top]
Q30. If I choose to Early
Board my electronic claims, from which contractor will I receive my electronic
remittances (ERA)?
A30. The ERAs will come
from your legacy (outgoing) contractor. PLEASE NOTE: The legacy contractor ID
will appear on the remittances for early boarding claims.
Updated: 07/10/08 [Back to top]
Q31. Will we be able to
receive the remittances from both NGS and GHI?
A31. You will only receive
a remittance from the contactor that processed the claim.
Updated: 07/10/08 [Back to top]
Q32. Will these scheduled J13 calls be repetitive
or do I need to listen into every call?
A32. As new information
comes out we will add that information to the calls. We do have a dedicated tab
on our web site at www.ngsmedicare.com
dealing with the Jurisdiction 13 Transition.
All changes will be posted in this section. You can visit that tab at http://www.ngsmedicare.com/ngsmedicare/PartB/J13/J13PartB.aspx
Updated: 07/10/08 [Back to top]
Q33. In regard to the
Local Coverage Determinations (LCD), the effective date of these policies are
the date of services equaling the cutover date (e.g. For Connecticut providers the date is 08/01/2008). If I submit a claim
a few days prior to the cutover and it is not processed at the current
contractor before the cutover date, what policy will apply?
A33. The policy that is in
effective at the time services are rendered will be the policy you should
follow. The new LCDs will be effective
based on our implementation/cutover date.
There are 5 cutover dates, listed below for each
segment/jurisdiction.
|
Contractor Type
|
Contract Number
|
Effective date for
LCDs
|
|
Connecticut – Part A
|
13103
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11/14/2008
|
|
Connecticut – Part B
|
13102
|
08/01/2008
|
|
New York – Part A
|
13201
|
11/14/2008
|
|
New York - Part B (Downstate,
excluding Queens)
|
13202
|
07/18/2008
|
|
New York – Part B (Upstate)
|
13282
|
09/01/2008
|
|
New York – Part B (Queens)
|
13292
|
07/18/2008
|
The date of the cutover
is the effective date of the LCD.
Updated: 07/10/2008 [Back to top]
Q34. NGS (Legacy Empire)
is my Part B contractor and I already bill NGS. What changes will affect?
A34. There are 2 important
changes that you need to be aware of for transition.
There are changes to the Local Coverage Determinations (LCDs) that
you need to familiarize yourself with before transition. Please review the policies that may affect
your specialty. There are 137 new J13 policies that have been posted to our
website. The LCDs can be found at http://www.ngsmedicare.com/ngsmedicare/PartB/J13/J13PartBLCD.aspx
The 2nd change is for electronic submitters. Even though NGS is your current Part B
contractor, you will still need to make a change to you electronic files. You will need to change the Contractor
ID/Payer ID to the new ID associated with the J13 A/B MAC. The new ID for Downstate New York Part B
(excluding Queens) is 13202. For
additional information on this change, visit our website at http://www.ngsmedicare.com/ngsmedicare/PartB/J13/Downstate.aspx
Updated: 07/10/08 [Back to top]
Q35. Will there be
additional staff added to the customer services lines?
A35. Yes, we currently
have staff in training and will be adding additional staff prior to and after
the cutover.
Updated: 07/10/08 [Back to top]
Q36. Is there an issue with providers having two
separate PTAN’s?
A36. If a provider has
more than one PTAN and is only actively using one, it is our recommendation
that the provider collapse their PTAN numbers or send
us a preferred PIN/PTAN letter informing us of the intended
PTAN.
Updated: 07/10/08 [Back to top]
Q37. Are the mailing addresses going to change?
A37. Yes, we will publish
the addresses and telephone number changes approximately two weeks prior to the
cutover date. This information will be available on our website under the
Jurisdiction 13 Transition tab. It will also be sent out via the listserv.
Updated: 07/10/08 [Back to top]
Q38. I am a Part A
provider for CT and NY what do I need to do since we are already part of NGS?
A38. There are 2 important
changes that you need to be aware of for transition.
There are changes to the Local Coverage Determinations (LCDs) that
you need to familiarize yourself with before transition. Please review the policies that may affect
your specialty. There are 137 new J13 policies that have been posted to our
website. The LCDs can be found at http://www.ngsmedicare.com/ngsmedicare/PartB/J13/J13PartBLCD.aspx
The 2nd change is for electronic submitters. Even though NGS is your current Part A Fiscal Intermediary, you will still need to make a change
to you electronic files. You will need
to change the Contractor ID/Payer ID to the new ID associated with the J13 A/B MAC. The new ID for Part A is 13201. For additional information on this change,
visit our website at http://www.ngsmedicare.com/ngsmedicare/PartA/Claims/EDI/IndexEDIPartA.aspx
Updated: 07/10/08 [Back to top]
Posted: 07/18/2008
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