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 MEDICARE CARRIER CHANGES
by Kathy Ransom, Support Services
The Centers for Medicare and Medicaid Services (CMS) issued a final rule on November 26, 2006 enacting Section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. Section 911 of the MMA required the (CMS) to replace the current fiscal intermediary and carrier contracts for the administration of Medicare benefits with new contracts with Medicare Administrative Contractors (MACs) who will administer both Part A and Part B. The duties of the selected MACs will include not only claims processing but also customer service, provider education, financial management, payment safeguards and information systems security.
Per the final rule, the country will be divided into fifteen “A/B Jurisdictions” and each A/B Jurisdiction will be assigned to one MAC, who will administer both Part A and Part B claims.
This is a list of the States that will be changing and the dates the change takes place:
- California – June 2008
- Iowa – February 1, 2008
- Hawaii – June 2008
- Nevada – June 2008
- Colorado – March 21 2008
- New Mexico – March 1, 2008
- Oklahoma – March 1, 2008
- Texas – June 13, 2008
- Kansas – March 1, 2008
- Missouri (Western) – March 1, 2008
- Missouri (Eastern) – June 1, 2008
- Nebraska – March 1, 2008
- District of Columbia – September 2008
- Delaware – September 2008
- Maryland – September 2008
- New Jersey – September 2008
- Pennsylvania – September 2008
Ortivus Support Maintenance Agreement (SMA) Customers can view a recorded webinar which addresses the changes that will need to happen within the billing program here: https://www1.gotomeeting.com/register/354001365.
Also, for up-to-date information, you can visit our Medicare Carrier Changes Resource Center by logging into the support section of our website: http://www.ortivusna.com/Support/support.asp
and then clicking on the Medicare Carrier Changes button on the right
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 SUPPORT Q&A SECTION
by Kelly Rothlisberger, Support Services
QUESTION: Soon I will need to send only NPI to specific carriers. Once my carrier notifies me that I should only send the NPI, what changes do I need to make to my program so that only the NPI is sent and not my legacy provider number?
ANSWER: For electronic claims there are new questionnaire items for Payor codes that will handle turning off the legacy provider number. DO NOT remove it from your company code. You will need to have the most current ISP (Industry Service Pack) that is available on our website. Login to www.ortivusna.com and then go to the Ortivus Downloads section. The screen shot below shows the warnings and where to get the industry service pack.
Once you have downloaded and applied the ISP, you will need to turn on the new questionnaire items for the Payor code. In Sweet-Billing, click on the Utilities menu and select Code Setup. Choose Payor Codes from the drop down list and then choose ECM- Send Provider ID. You will want to answer the default question as No. The selected answer of ‘No’ will suppress the legacy provider id from your electronic claim file for a specific payor. The following screen shots display where to turn the questionnaire on and then also how to answer the question on the Payor code.
For paper claims, there are also questionnaire items for the Payor Codes. The screen shots below include some examples for the Payor code questionnaire items. These questionnaire items work the same way that the electronic claims questionnaire item works. When answering the questionnaire item as ‘No,’ the Provider ID number doesn’t print on the form.
QUESTION: I am updating to 5.3 soon, what do I need to do prior to performing the update?
ANSWER: All customers are strongly encouraged to watch the recorded class on 5.3 enhancements available on our website in the Recorded Classes Center, and to read the release notes prior to the update. While we are very excited to bring you 5.3.x versions, these updates brought about many changes to the program- many of which you (our customers) have asked for!! Some highlights include the addition of the NEMSIS fields to Sweet-Billing and Sweet-Field Data, the use of color in the remote unit and a few new options when filtering reports. While continued government changes have dictated our program releases for the past few years, version 5.3.1 allowed Ortivus to put in place some customer enhancement requests, truly making this version a customer driven version!
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