MOASC sponsored Palmetto GBA General Transition Updates and Part B Claims Update

The following information is provided by MOASC and ANCO members are invited to participate in this teleconference.



Below is the outline of discussion for the Thursday, August 21 teleconference at 10:30am – 12:00pm.
Please do not hesitate to bring your questions to this conference call.

The call in information is:

866-212-0875
Passcode: 469922

PLEASE PRESS *6 TO MUTE AND UN-MUTE YOUR LINE DURING THE CALL.

If you have any questions, please do not hesitate to contact the MOASC office.
Thanks!

Phone: (909) 985-9061
Fax: (909) 985-8581
P.O. Box 161
Upland, California 91785-0161
moasc@moasc.org



Palmetto GBA General Transition Updates and Part B Claims Update

Presented by:

Pat Boardley
Palmetto GBA, J1 Manager Provider Customer Service

And

Margo Simpson
Palmetto GBA, Provider Outreach and Education


Regardless of the date of service, all claims processing, customer services and payments will be handled by Palmetto GBA as the J1 MAC, beginning September 2, 2008. NHIC will transfer all pending and in-process operations, all history previously on file with NHIC and pending work, to Palmetto GBA at that time.
On Thursday, August 28, 2008, Segment 3 of the Medicare Part B workload will begin its transition from NHIC, Corp (NHIC) to Palmetto GBA. The transition of Segment 3 affects Part B providers in California.

Discussion regarding important transition information for Medicare Part B providers in California will be addressed.


DATE: Thursday, August 21, 2008

TIME: 10:30 A.M. - 12:00 P.M.



Please RSVP to moasc@moasc.org by August 20 to receive call-in information and handouts.

Palmetto GBA Jurisdiction 1 MAC Part B Transition Update Agenda
Medical Oncology Association of Southern California

August 21, 2008




California Transition Updates

Implementation Schedule for Segment 3
California Part B
Contractor Workload Operational Date
NHIC California
Part B 9/2/08

Regardless of the date of service, all claims processing, customer services and payments will be handled by Palmetto GBA as the J1 MAC beginning September 2, 2008.

NHIC will transfer all pending and in-process operations, all history previously on file with NHIC and pending work to Palmetto GBA at that time.

Inquiries or Appeals - Effective September 2, 2008, if you have an inquiry or want to request an appeal on a claim processed prior to September 2, 2008, you will contact Palmetto GBA.

Provider Enrollment - All provider enrollment applications currently in process with NHIC will be transferred to Palmetto GBA at cutover for completion.

“Dark Days” - In order to complete the transition of the Medicare Part B workload for California, NHIC and Palmetto GBA will need to observe “dark days”. A “dark day” is defined as a day in which the Medicare claims processing system is not available for normal business operations. There will be no online access, current claim information will not be provided via the IVR or Provider Contact Center, and claims will not be processed.

“Dark days” for NHIC will be Thursday, August 28, 2008 and Friday, August 29, 2008, and for Palmetto GBA on Monday, September 1, 2008. Claims processing systems will not be available during the cutover weekend. Tuesday, September 2, 2008, will be the first day for all operations for Palmetto GBA, to include the Provider Contact Center and

Customer service

Interactive Voice Response (IVR) - The Palmetto GBA’s IVR system should be provider’s first point of contact for customer service. You are able to check claim status, eligibility, information for redetermination, the reason for denials, and check status. There is a voice message to provide options for each region. The IVR option for California is ready for service however there is a message letting providers know this region will transition Sept. 2nd.

IVR job aids – Are located through links on the J1 web site’s home page.
Part B IVR: (866) 931-3903
Customer Service Representative: (866) 931-3901
TTY: (866) 931-3902
Call Center Hours: 7 a.m. – 5 p.m. Pacific Time

Providers will need to have their NPI and transaction PTAN # available. There is also a voice message with options for the IVR - press 1 for NV-HI, option 2 for Northern CA, option 3 for Southern CA. A recorded message will let providers know CA provider records will not be available until September 2nd.

Electronic Data Interchange
Do Not Hesitate to Begin the Early Boarding Process
Take advantage of our Early Boarding option and become comfortable with submitting and receiving EDI transactions from Palmetto GBA. Ensure that you are not caught up in the inevitable delays in support and response times that happen when latecomers overwhelm support resources at the last minute.

Please call the Palmetto GBA EDI Technology Support Center (TSC) at (866) 749-4301 for assistance with EDI issues that are not addressed on the Web site. The TSC is available Monday through Friday from 8:00 a.m. to 5:00 p.m. PST.

Medical Review - Providers responding after September 2, 2008, to medical review additional development requests from NHIC should return the responses to:
J1MAC Palmetto GBA
PO Box 1476
Augusta, GA 30903-1476
or FAX the information to 803-462-3929.

Local Coverage Determination - For Segment 3 (California Part B), services provided on or after September 2, 2008 will be subject to J1 local coverage determinations (LCDs), while services provided prior to September 2, 2008 will be subject to NHIC’s LCDs. This is especially important in case of any redeterminations or post-pay review.

On-going Education – Providers will receive continued Medicare education via webinar and specialty seminars, as well as participate in educational forums.

Questions and Answers