Jurisdiction H Implementation Background and Important Steps for Physicians

Transcription

1 .., Jurisdiction H Implementation Background and Important Steps for Physicians 1. Planning meetings involving CMS, the incoming contractor and the outgoing contractors began in March and are ongoing. 2. TrailBlazer will post information on our website, but it will be prudent to follow developments on the Novitas website at: 3. Sign up for the appropriate Lists on the Novltas JH Transition web page. 4. The cutover for Part A is estimated as 10/29/ The cutover for Part 8 is estimated as 11/19/ Generally, until the cutover date, all transactions (claims, provider enrollment, customer service, appeals) are sent to current TrailBlazer addresses. As we get closer to cutover, Novitas will publish specific dates when transactions must be sent to them. 7. Key areas to monitor: EDI, EFT agreements, Outreach sessions, and Important dates. Pay careful attention to Novitas announcements concerning these critical areas, especially EFT. Some information regarding EFT agreements is already available on their website. 8. Enrollment: TrailBlazer will not issue any NEW revalidation requests. However, we will follow-up on revalidation requests we mailed in March or April, so please respond if you get a letter or phone call from TrailBlazer. 9. The RAC and the ZPIC are not changing. There will be a temporary suspension of new RAC requests beginning 90 days prior to cutover and continuing for 90 days post cutover. 10. The final LCOs for JH will be posted on the Novitas website before the end of June. They tentatively plan to have 125 LCOs in JH; TrailBlazer only has 118, so some will be new and others could differ from TrailBlazer's existing LCD. Novitas' approach to implementation may also differ from TrailBlazer's approach. o Current TrailBlazer LCOs are still in effect for any dates of service up to the cutover date (10/29/2012 for Part A providers; for Part B).. o The new Novitas JH LCOs will be in effect for any dates of service after the cutover date. ~TrailBlazer HEALTH ENTERPRISES, LLC c~s Published June Trailblazer Health Emerprisesr/Tralllilazer". All rights reserved CENTERS for MEDICARE & MEDICAID SERVICES

2 Our commitment SOLUTIONS Novitas will operate in such a manner that fully demonstrates our commitment and dedication to: Integrity and compliance Fiscal responsibility Operational excellence Continuous improvement Meeting our stakeholders' goals and expectations ' ~.'.,." "~r~""~" ",--~- :~; '0" '"._ -_-.".' "",, ",.. ". ',"".".,.,I ",._,,!

3 Fast Facts SOLUTIONS Jurisdiction H Jurisdiction 12/L Annual Claim Volume % of National Workload Annual Benefit Payments Beneficiaries Part B Providers Hospitals Other Facilities '" 165 Million 13.2 "'$ 49 Billion 9.9 Million 155,000 1,285 5,601 '" 125 Million 10.9 "'$ 39 Billion 8.6 Million 158, , "'~'\;"''':'., "'-""''''\'-"'''''~'''''''''~'''''''r''''''\ ", -""'/.'-:,,".,..,......, - '.....,."..-" ~.\,.,,,"..'... ;-.-.. ~ '. ' \,"..... " ",":,v.", " ,..:'..... "."... ;", '1"","." -.

4 Key Implementation Items Timeline

5 Communications SOLU"T'IONS -Oblectlve - Identify the processes and procedures that will ensure all stakeholders are informed of the implementation, its progress, and any impacts Primary Groups Professional Associations/Organizations Government Beneficiaries/Advocacy Groups Other ems Contractors 7,. ;>"":""",. '"I." ".... ", '".,", ' '1.'.~",.. '.. '..'

6 . Outreach & Education Professional Groups/Billers SOLUT10f'\!S ~Medical Societies ~ Hospital Associations ~Providers ~ Rural Provider Organizations ~Mass Immunizer Billers ~ IHSlTribal Billers ~ Veteran Affairs ~Non- Physician Providers (e.g. Ambulance, Labs) ~ AAHAM/MGMA/HFMA Chapters ~EDI Billers 8...,......".,~" '-.'."...,,~...,"... ".....",-...,.,_.,." ij : i.~ ;.,'..','l". I '",., '" I,'.1,"

7 Key Communication Venues SOLU"f"!ONS In-person meetings Transition Consulting Teams Listservs/Social Media Website - Newsletters/Policy/EDI - Alerts/Updates - Frequently Asked Questions (and Answers) - Inquiries a-,... "T'-- '" "-;-'~T"',," '.,., "... "..'.."...,,.....

8 ISO SOLUTIONS Novitas Solutions, Inc. A ems CONTRACTOR eemlfi5-0 Home I ACr'onyms I Ac~essibuttvlSOB! Caf"eers r Links I Site Hefp 1Site M.ap 1 Contact Us or US.E' the M<?dica.iPolicy Search or th.s: Advanced Search. arc~.j WefcO'm'.e to r.tovitas Solutions' dedicated infornllttion center for the teeusttten of ArkanslDs, Colorado., f..cnjisillna, Mlssissippi,. Ne;\~ Mexico, OkJahoma',. and Te.xas workloads into MAC JH. r.tovitas bas c:onfinned 002!!!..~af'g fo tpe...1hlm!jfementation. ~..!~~?:-.!~~~~ [nfonr...eoor.. on. how ths.ih tr.;n:sitiqn wit:.m~t ~1>3UG~'T.g t1e\.ysetlt~ ~ uyt:'o-miru;! tr.ainin] C'P-;'<trtt.t.n!tMs. ~? q;.testum to :a~ sb.qut the.»-i ST9nsiti=>-'I'l?. PBSt lyt/'mome lettgr'. ~.JJP.li n,~'l,~~":':y"orfd.o~.lnllf,tt!2.:;;,.!'j!:. K.tJ;f;r!Lq~;,.s;~!!9..1.:.~..I!::~ft~~?n., :Q:.t;l.;~~!l ~~J~_~~..Q!j,'i>1!.~t~~.'!J'.!'"f~..P~~..!t'tfi:.rmationabout hvv'lthe JH transition win affect you is coming soon. ~1..m:~@llL~-wr..,s.D.!l!.. Effioe.~ tin:ct. and int~8ig~.,,':e-s...,*,ii~ns fu:- our a.:swar,.:o..r:s ~ '. Wii~=?S assfgn Sf nt=!w EOl st.!bm!twit'e'c~ter ar.m ~ ID7. vti!!,.-eed nerj" QQ!Land PPl1l Access~ ~~~ apptv fm- roe'&; RA\..-F ms to ~,~ '" if"f ~tfy u~ a "~etwo~ S~~C!l?:" Vle~:fJ.~;(lSn tp {:~lect tq. my 9.!$l"ent ~~~.\:9.G...!'f.iiU~=~~<;J;"rith"!!,,",J!!~.!ha.t..2!~!H.:"~~'I!!:'f~ ID2U::~_~&!l Q;""<li9rtS,"!O''''ns.J ~jg~~~ Veflitoo._~Q..1Q:rrll@!4@..qK~!:~~~~~~~(I~)[!,,~... Read more about JH LCD D~velopm03nt.1:!!l~f.ID1m<ml!.t~~!l'5"~J~~~m 1 ~ ~Sit,,~ ~~~! "f"",,"'~fjoin-e-tl il,ists 1 ~..!.!l; I.Sewredl@BsitioQ.Team ~ ~;.. :,,;.:U.. ::-: ::: ':...,.,'. '.", '-.,-: ::.:-:. :.":~.:';.'.. ;' '-":'-..:' ;:.!, -,..:.:.::~':"~:~"::'.~ ::' " :,: -.; :.'..: ',7-;,; ~.:", -::..:f-;'::: -,;.:':::::.~<.: '..::..:',.::..;';: ::.;:'",;:: ::..:;:..:::: ::'.:':::::f;'~:'!;~ :;;~!:':: ~:::-,.;,>., ~.--.~ ~ !

9 Local Coverage Determinations SOLUTIONS General Scientific Basis Data Driven CAC members playa key role Contractor Advisory Committees State Based Existing Schedule initially JH Local Coverage Determinations Created from J4/J7 Policies Submission to CMS : 5/11/2012 Posting of LeDs : 6/28/2012 LCD reconsideration process 11,.....,.. '1.".,,'t

10 Who are we? SOLlrrlON5 Novitas Solutions, Inc. (Novitas), formerly Highmark Medicare Services Inc., is a wholly-owned subsidiary of Diversified Service Options, Inc. (OSO), a subsidiary of Blue Cross Blue Shield of Florida (BCBSF) DSO was established in 1998 for fee-for-service government business, which today includes Novitas, First Coast Service Options (FCSOLand 50% ownership in Tri-Centurion. Novitas and its predecessor organizations have been a Medicare contractor since the inception of the Medicare Program. Novitas currently serves as the MAC for J12 (PA, NJ, MO, DE, and DC) and the administrator of the nationwide Section 1011 contract for Federal Reimbursement of Emergency Services Provided to Undocumented Aliens 1 -..,.... v.,, '~,.,. '-'. -,. '"""'."'-.....,... '-'"._,.. ~,'",..,."...,.....,.,.." ". '.'I~....,..., ,..... ;.''''....,".,.. ~ "......,.,' ,..., 'r.'

11 Where are we? ":"":'.-:'.: cl"l,lut!ons _I \..- Existing Locations Camp Hill Williamsport Pittsbu rgh Hunt Valley, MD '* New Offices Jacksonville, FL Milwaukee, WI Dallas, TX 2

12 Medicare FFS Regions Diversified Service Options 3, '--'-~'-"~ ",." I'. A "', ""~-'-'''''.- _ r:-':""'r : 'oj... -, -.",".,~,.... I., ", ~... ~:_.",.. l