Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 296 Date: OCTOBER 19, 2007

Transcription

1 anual ystem Pub One-Time Notification epartment of ealth & uman ervices () enters for edicare & edicaid ervices () Transmittal 296 ate: OTO 19, 2007 hange equest 5651 ubject: New Numbers for ll Jurisdictions. UY O NG: This informational hange equest () is to notify all interested parties that the enters for edicare and edicaid ervices () will assign new numbers for all jurisdictions. New / evised aterial ffective ate: utover dates of segments mplementation ate: arliest cutover date for a segment is ecember 1, 2007 isclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NG N NUL NTUTON: (N/ if manual is not updated) =V, N=NW, =LT-Only One Per ow. /N/ hapter / ection / ubsection / Title N/. UNNG: ontractor activities are to be carried out within their operating budgets. V. TTNT: One-Time Notification *Unless otherwise specified, the effective date is the date of service.

2 ttachment One-Time Notification Pub Transmittal: 296 ate: October 19, 2007 hange equest: 5651 UJT: New Numbers for ll Jurisdictions. ffective ate: utover dates of segments mplementation ate: arliest cutover date for a segment is ecember 1, GNL NOTON. ackground: The purpose of this hange equest () is to notify all interested parties that the enters for edicare & edicaid ervices () will assign new numbers for Jurisdictions. edicare contracting reform requires that the use competitive procedures to replace its current fiscal intermediaries and carriers with a uniform type of administrative entity, referred to as edicare dministrative ontractor (). s such, new numbers are required to identify the work being performed by the new contractors. The numbering scheme allows for three tiers of numbers to meet the current and future needs of and its contractors. The bottom tier is the workload number, which uniquely identifies each workload by claim type and state as described below. The second tier number is the Part number, Part number, (urable edical quipment) number, or (ome ealth and ospice) number. This number is the aggregate for each of the claim types processed within each jurisdiction and is commonly referred to as the roll-up number. The top tier consists of a single jurisdiction number which uniquely identifies each and includes all claim types processed by that jurisdiction. s the implementations move forward, it is imperative that: 1) all components and contractors understand the numbering convention and what it represents; 2) all claim processing and financial system applications recognize/process the appropriate numbers; and 3) all components use the appropriate number that best meets their needs within the overall numbering scheme as described below. When each jurisdiction is awarded and cutover dates are finalized, a change request will be issued with the appropriate numbers for that jurisdiction. Workload Number: or Part and Part, there will be a unique workload number for each state within the 15 Jurisdictions. That number may be appended with unique usiness egment dentifier (), which also represents the state and is used in certain applications and workload reporting. The following shows an example for the tate of Kansas in Jurisdiction 5. Workload Number usiness egment dentifier K Jurisdiction tate Used in laim tate ndicator Part indicator indicator future to Type* by state indicate alphabetical a change order within of the Jurisdiction contractor K Jurisdiction tate Used in laim tate ndicator Part 1

3 indicator indicator future to Type* by state indicate alphabetical a change order within of the Jurisdiction contractor * laim type designations: Part = 1; Part = 2; = 3; = 4 Part, Part,, or Number (a.k.a. oll-up Number): This number is for components requiring a roll-up number for Part and Part for the 15 / s (e.g., financial reporting) or a or number. There will be no or state indicator for these numbers. The Part and Part examples are shown for the state of Kansas. The 4 Jurisdictions (Jurisdictions,,, and ) are identified for numbering purposes as Jurisdictions 16, 17, 18, and 19 respectively. our / s (Jurisdictions 6, 11, 14, and 15) will be responsible for processing claims. ach of those s will process claims for a designated jurisdiction, configured in the same manner as the jurisdictions. The following four examples illustrate the application of the roll-up number for each of the different claim types. Part (oll-up) Number Jurisdiction indicator Part (oll-up) Number laim Type* Jurisdiction indicator Number laim Type* Jurisdiction indicator Number laim Type* Jurisdiction indicator laim Type* * laim type designations: Part = 1; Part = 2; = 3; = 4 Jurisdiction Number: This would be the number representing the entire jurisdiction. This would be used by an application desiring an all-inclusive jurisdiction number. Jurisdiction Number Number Table: Jurisdiction 5 Jurisdiction Number Part /Part (oll-up) Number 2

4 Workload Number owa Kansas K K issouri O O Nebraska N N The following chart shows all numbers that may be utilized for all jurisdictions. Jurisdiction Workload Type Workload Number tate oll- up arliest llowable ut over ate /01/ /01/ NV 6/01/ /01/ /01/ NV 2/ K 2/01/ /01/ O 5/01/ W 2/01/ K 2/01/ /01/ O 2/01/ W 2/01/ Z ompleted T ompleted N ompleted ompleted UT ompleted WY ompleted Z ompleted T ompleted N ompleted ompleted UT ompleted WY ompleted O 5/01/ N 5/01/ OK 3/01/ TX 5/01/ O /01/ N 3/01/ OK 3/01/08 3

5 Jurisdiction Workload Type Workload Number tate oll- up arliest llowable ut over ate TX 5/01/ /01/ K 3/01/ O 5/01/ N 12/01/ /01/ K 3/01/ O 3/01/ N 3/01/ L 3/01/ N W 3/01/ L N W /01/ L /01/ /01/ /01/ L /01/ /01/ N 3/01/ N 3/01/ L 3/01/ P/V L 3/01/ P/V L 2/01/ G TN 3/01/ L 2/01/ G /01/ TN 3/01/ N V 12/01/ WV 12/01/ N /01/09 4

6 Jurisdiction Workload Type Workload Number tate oll- up arliest llowable ut over ate V 3/01/ WV /01/ /01/ /01/ NJ 2/01/ P 2/01/ /01/ /01/ /01/ NJ 5/01/ P 5/01/ T 6/01/ NY 6/01/ T 5/01/ NY 3/01/ /01/ /01/ N /01/ /01/ VT 3/01/ N /01/ VT KY 6/01/ O 6/01/ KY 6/01/ O completed completed completed completed ome ealth and ospice K 12/01/ L 12/01/ T 12/01/ L 3/01/09 5

7 The following systems shall reflect the new contractor number:,, T,, O, OW,, W,,,,, GL,, LOL, PaT, National laims istory, NG, O, PO, P, PO, P&, PO, PUL,,, T, V, W, and all free billing software.. Policy: N/. UN QUNT TL Use hall" to denote a mandatory requirement Number equirement esponsibility (place an X in each applicable column) W,,, and the edicare systems listed in requirements 5.2 through 5.36 shall be modified to reflect the new contractor number as issues instruction to do so. This is for planning and programming purposes W,, and the edicare systems listed in requirements 5.2 through 5.36 shall be able to implement the new contractor number when notified by shall be modified to reflect the new T shall be modified to reflect the new shall be modified to reflect the new OW shall be modified to reflect the new and P shall be modified to reflect the new shall be modified to reflect the new shall be modified to reflect the new NP rosswalk ontractor shall modify the system to accept the new contractor number PaT shall be modified to reflect the new NG shall be modified to reflect the new / hared-ystem aintainers V W X X X X X X OT T OW P NP PaT P shall be modified to reflect the new P NG 6

8 Number equirement esponsibility (place an X in each applicable column) PO shall be modified to reflect the new PUL shall be modified to reflect the new shall be modified to reflect the new shall be modified to reflect the new atamatch files for the workload shall be sent on separate files from the Part workload to the appropriate contractor VP shall modify uperop with the new contractor number as appropriate O/O shall be modified to reflect the new The individual Ps shall make any necessary modifications if needed to reflect the new LOL shall be modified to reflect the new T shall be modified to reflect the new shall be modified to reflect the new shall be modified to reflect the new ll free billing software shall be upgraded to reflect the new PO shall be modified to reflect the new Quality all onitoring shall be modified to reflect the new PO shall be modified to reflect the new contractor number O shall be modified to reflect the new The ontractor shall work with the to modify its records to reflect the new P& shall be modified to reflect the new contractor number Part pricing files (i.e. Purchase diagnostic, ambulance) and zip code files 7 / X hared-ystem aintainers V X X X W OT PO PUL VP O O P LOL T N PO Q PO O P& X X X X PNG N ZP

9 Number equirement esponsibility (place an X in each applicable column) shall be modified to reflect the new shall be modified to reflect the new contractor number W shall be modified to reflect the new contractor number GL can use the contractor number or rollup number or in certain situations not use either number W LG module shall be modified to reflect the new contractor number T shall be modified to reflect new contractor number / hared-ystem aintainers V W X OT O W GL W LG T. POV UTON TL Number equirement esponsibility (place an X in each applicable column) ontractor will inform providers about the change in the edicare contractor numbers. The contractor shall post this information on their Web site and include information about the number change in a listserv message. ontractors are free to supplement this education with localized information that would benefit their provider community in billing and administering the edicare program correctly. / X hared-ystem aintainers V W OT V. UPPOTNG NOTON. or any recommendations and supporting information associated with listed requirements, use the box below: Use "hould" to denote a recommendation. 8

10 X-ef equirement Number ecommendations or other supporting information:. ontractor inancial eporting/workload mpact: The Jurisdiction workload shall be reported using the new V. ONTT Pre-mplementation ontact(s): or or or Post-mplementation ontact(s): or or or V. UNNG: or edicare dministrative ontractors (): The contractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work (OW). The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. or Title XV contractors: N.. 9