If you are a Riverbend customer in New Jersey currently using Electronic Funds Transfer (EFT) to receive your Medicare payments, please be on the lookout for this important letter advising you of the transition impact to you and what you need to do to respond. Please mark your CMS-588 Form as “Revision to Current Authorization” and print MAC at the end of that line on the CMS-588 Form to assist in processing. Remember to list Highmark Medicare Services as the contractor in Section V on page 2.
Dear Provider:
Welcome to Highmark Medicare Services, the Jurisdiction 12 (J12) Medicare Administrative Contractor (MAC). Our goal is to ensure a smooth transition of your services from your current contractor to Highmark Medicare Services. As part of the transition, Highmark Medicare Services is required to obtain a new CMS-588 EFT Agreement (Electronic Funds Transfer Authorization Agreement) from each provider/supplier who is currently receiving Medicare payments electronically before we may make payment to you via electronic funds transfer. Failure to complete and submit a CMS-588 Form will result in a delay or interruption of your Medicare payments at and after transition.
In order to avoid delays in your Medicare payments, please complete the enclosed CMS-588 form and return it by June 20, 2008 to:
Highmark Medicare Services,
Provider Enrollment Services
1800 Center Street
PO Box 890157
Camp Hill, PA 17089-0157
Please read the following tips for correct completion of the CMS-588 form. In Part I, check “Revision to Current Authorization” as the reason for submission and write MAC on that line. Part II of the CMS-588 requires the CMS Certified Number (CCN) to be reported on the form as the “Medicare Identification Number.” The CCN noted at the top of this letter is the CMS Certified Number, formerly known as your OSCAR Number. Please remember to list Highmark Medicare Services as the contractor on the top of page 2 in Section V. The form must be signed and dated by an authorized or delegated official on file with Medicare. The signature and date fields are on page 2 of the form in Part V.
NOTE: You are not required to complete a CMS-855 Enrollment form as part of this process.
If you have any questions about the completion of the CMS-588 form, contact the Provider Enrollment Helpline at 1-866-488-0549. In addition, further details can be found on our J12 Transition webpage.
Thank you for your cooperation. We look forward to serving you.
Sincerely,
Judy Andidora, Manager
Provider Enrollment Services