General
- The effective date of the LCDs on the website is 07/11/08; however, our SIPP II cutover date is 08/01/08. Which date is the LCD effective date for PA/MD/DC Part A?
- Are there only one set of policies for both Part A and Part B?
- Are the 57 posted LCDs the only LCDs we need to follow?
- Do the SIPP I Part B dark days affect Part A claims processing and activities?
- Do EDI claims submitted during the dark days retain their original submission date?
- Highmark Medicare Services is our current Fiscal Intermediary. How will this transition affect us?
- Do I have to resubmit a CMS-588 form if I currently bill Highmark Medicare Services?
- Do I have to do anything to continue to receive my payments electronically?
- Does Highmark consider its current staffing levels adequate for current workload?
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The J12 MAC LCDs will be effective with each segment cutover, and the first segment cuts over on 7/11/08. For SIPP II, the J12 MAC LCDs will be the policies applicable to services billed to Highmark Medicare Services effective with dates of service on or after August 1, 2008.
Date Posted: 07/11/2008, Date Reviewed/Revised: 07/15/2008
Are there only one set of policies for both Part A and Part B?
During the Transition period, July 11, 2008 through December 12, 2008 the LCDs will be the same for Part A and Part B to the extent possible.
Date Posted: 07/11/2008
Are the 57 posted LCDs the only LCDs we need to follow?
Effective for dates of service on or after August 1, 2008, the Highmark Medicare Services J12 MAC LCDs will be the policies applicable to services billed to us as the J12 MAC Contractor. As your current intermediary, for dates of service prior to August 1, 2008, Highmark Medicare Services will be posting an index on our website to reach all PA/MD/DC Part A LCDs that were active at the time of cutover. The index will provide you a link directly to the specific LCD on the CMS Coverage Database.
Date Posted: 07/11/2008
Do the SIPP I Part B dark days affect Part A claims processing and activities?
Each transition segment will have “dark days” specific only to that segment's cutover date. 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 our PA and MD/DC Part A providers will be August 2, 2008 through August 4, 2008.
Date Posted: 07/11/2008
Do EDI claims submitted during the dark days retain their original submission date?
The EDI business day ends at 4:00 p.m. Eastern Time, and claims received after that time are dated as of the next business day. EDI claims received after 4:00 p.m. EDT on Friday, August 1, 2008, through 4:00 p.m. EDT on Monday, August 4, 2008, will be entered into the FISS processing system Monday night, August 4, 2008. These claims will generate EDI reports for retrieval on Tuesday, August 5, 2008.
Date Posted: 07/11/2008
Highmark Medicare Services is our current Fiscal Intermediary. How will this transition affect us?
Several changes will take place effective on August 1, 2008. Those changes include:
- New telephone numbers have been issued to Highmark Medicare Services for the Customer Contact Center
- Contractor Workload Number will change
- New J12 Local Coverage Determinations (LCDs) will go into effect
- Payment Cycle for MD and DC providers will change from weekly to daily.
Date Posted: 07/01/2008
Do I have to resubmit a CMS-588 form if I currently bill Highmark Medicare Services?
No, you are not required to resubmit a CMS-588 form since you already have an existing agreement for Electronic Funds Transfer (EFT) with Highmark Medicare Services.
Date Posted: 07/01/2008
Do I have to do anything to continue to receive my payments electronically?
No. If you are currently receiving your Medicare payments electronically, you will continue to do so under MAC J12.
Date Posted: 07/01/2008
Does Highmark consider its current staffing levels adequate for current workload?
Staffing levels will be commensurate with the various workloads present in the MAC J12. We do not anticipate negative impacts to the provider community due to insufficient staffing levels.
Date Posted: 07/01/2008