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Noridian Jurisdiction JE: California’s New Medicare Administrative Contractor

Monday, July 22nd, 2013
Hopefully you’ve already heard that CMS selected a new Medicare Administrative Contractor (MAC) for California, and now that the lawsuits are settled (Palmetto did not go down without a fight) the switch is hot on our heels. Are you ready for implementation? If not, perhaps we can help by providing a quick update of what you can expect.
The jurisdiction we’ve known as Palmetto J1B will be known as Noridian’s Jurisdiction JE. The cut-over is set to take place as follows:
  • Part A Implementation/Cutover: August 26, 2013
  • Part B Implementation/Cutover: September 16, 2013

You do not need to register with Noridian. All data is set to change hands from Palmetto to Noridian without any new applications if you are currently enrolled in Medicare. I know of at least one clearinghouse that was sending messages stating that you had to register with Noridian’s EDI department and Noridian has confirmed that this is incorrect.

All currently processing enrollment applications, revalidations, claim appeals, etc are supposed to change hands from Palmetto to Noridian the weekend before implementation. Noridian will honor any deadlines issued by Palmetto, so do not expect the transition tol buy you extra time with appeals, data requests or timely filing issues. The Noridian transition team is urging the provider community not to resubmit data that you’ve already sent to Palmetto because they expect to see it turned over to them. Could they guarantee Palmetto would not accidentally forget anything? Of course not. My advice: Keep close tabs on anything currently processing and call Noridian after the cross-over to confirm that they have it. Due dilligence is required.

To minimize both provider headaches and nagative impact on cash flow, Noridian is keeping many things consistent with status quo.

Things that will remain the same with Noridian:

  • Electronic Funds Transfers  If you are set up with Palmetto, you will not need to reapply or make any changes.
  • Interactive Voice Response (IVR) Functionality
  • Listserv  If you are on a Palmetto listserv, your email information has been transferred to Noridian and added to their listserv. You already should have received emails from Noridian. This will keep you in the loop on educational events, deadlines, and any other informational releases as the cutover date approaches.
  • Local Coverage Determinations (LCDs)  Noridian will adopt the same LCD policies currently active under Palmetto. However, they will change the policy numbers. Keep an eye out for a policy number cross-walk if you are tracking this data.
  • Your EDI submitter number will not change.
Things that will change with Noridian:
  • Single Toll Free Customer Service Number  Noridian will consolidate all customer service numbers down to a single telephone number. After dialing in, you will be triaged to one of the appropriate departments:
    • General inquiries
    • EDI Support Services
    • Provider Enrollment
    • Phone Reopenings
    • User Security
  • No more invoices You will not have to submit invoice data with claims as sometimes required with Palmetto. Necessary information can be entered in Box 19 on the traditional CMS 1500 form.
  • New Provider Portal  The provider portal will change from the OPS system you use now to a portal called Endeavor. Like OPS, you will be able to check claim status, verify eligibility, and review single claim remits. You will also be able to view, track and reopen redetermination requests. You will need to register for Endeavor. Updates on how to register will be available closer to the implementation date.
  • You will receive new logins to the EDI system.
  • The contractor ID/code will change. This information will be available on the EDISS (Electronic Data Interchange Support Services) support page located at: EDISS Information. ABSOLUTELY DO NOT change the contractor ID on any of your claims until the cut-over date.

For detailed information on the implementation, FAQs, EDISS and “early boarding”, workshops, etc, visit the Noridian Home Page.