As part of the Centers for Medicare and Medicaid Services’ (CMS) consolidation of Medicare operations, Highmark Medicare Services will transition the New Jersey Part A operations from Riverbend to Highmark Medicare Services as the J12 MAC from Saturday, August 30, 2008 through Tuesday, September 2, 2008.
This notice is to communicate implementation activities for the cutover weekend of Saturday, August 30, 2008, through Tuesday, September 2, 2008, including any expected service interruptions and outages, so that you can properly prepare for it.
Note: Regardless of date of service, all claims processing, customer services, and payments will be processed by Highmark Medicare Services as the J12 MAC based upon the September 1, 2008 cutover date. Riverbend will transfer all pending and in-process operations to Highmark Medicare Services at that time.
“Dark Days” from 08/30/08 through 09/02/08
In order to complete this transition, Highmark Medicare Services will need to observe system “dark days”. During “dark days,” there will be NO access to the Fiscal Intermediary Standard System (FISS) to conduct claim entry or claim correction, and verify beneficiary eligibility and claim status as well as limited EDI processing.
The J12 MAC transition “dark days” for the New Jersey Part A providers will be August 30, 2008, through September 2, 2008. This includes Labor Day on Monday, September 1, 2008. In the event that a cycle delay or FISS availability delay occurs due to the transition, a listserv email and website notification will be sent with a status update and the estimated time of system and/or EDI report availability.
EDI Processing Availability 08/29/08 through 09/02/08
Riverbend will continue to accept EDI claims until 4:00 p.m. EDT on Friday, August 29, 2008. No claims for NJ Part A will be accepted by Riverbend after 4:00 p.m. on Friday, August 29th. Highmark Medicare Services will begin to accept electronic claims from NJ Part A providers beginning 4:00 p.m. EDT on Friday, August 29, 2008. All claims received by Highmark Medicare Services between 4:00 p.m. on Friday, August 29 and 4 p.m. EDT on Tuesday, September 2, 2008, will be entered into the FISS processing system Tuesday night, September 2, 2008. These claims will generate EDI reports for retrieval on Wednesday, September 3, 2008. In the event that a cycle delay or MCS availability delay occurs due to the transition, a listserv email will be sent and an alert will be posted to our website:
http://www.highmarkmedicareservices.com/transition/j12/index.html
with a status and the estimated time of system and/or EDI report availability. Please remember to use your new Highmark Medicare Services EDI Submitter Identification, Login ID issued to you on July 9, 2008, as well as the new Contractor Workload ID Number.
FISS/HIQA Availability from 08/30/08 through 09/02/08
The FISS will NOT be available on Saturday, August 30th, through and including Tuesday, September 2nd. Therefore, all Direct Data Entry (DDE) functions, such as claim entry, claim correction, beneficiary eligibility (HIQA/HUQA), and claim status, will be unavailable. Access to FISS/HIQA will resume on Wednesday, September 3, 2008.
Payment Cycles
Providers should be aware that Riverbend had previously paid New Jersey Part A providers three times per week. As part of the transition, Highmark Medicare Services will be moving to a daily payment cycle for New Jersey Part A providers. However, as a result of the transition activities, the first payment cycle run by Highmark Medicare Services for New Jersey Part A providers will take place on Wednesday night, September 3rd. Checks and EFTs created from this batch cycle will be dated September 4, 2008. In addition, the first Electronic Remittance Advice (ERA) for New Jersey Part A providers will be created from the September 3rd payment cycle.
Customer Contact Center and IVR Availability from 08/29/08 through 09/03/08
Due to the New Jersey Part A transition, the IVR will NOT be available beginning Friday, August 29, 2008, at 4:30 p.m. EDT and continuing through 6:00 a.m. EDT on Wednesday, September 3, 2008.
ATTENTION - In order to communicate any disruptions during our transition period, Highmark Medicare Services will continue to provide updated communications regarding possible impacts to Medicare Part A providers in New Jersey on our website at www.highmarkmedicareservices.com as well as our J12 MAC transition listserv.