anual ystem Pub 100-20 One-Time Notification epartment of ealth & uman ervices () enters for edicare & edicaid ervices () Transmittal 1600 ate: January 29, 2016 hange Request 9456 UBJT: Award of edicare Administrative ontractor (A) ontract for Jurisdiction 15 I. UARY O ANG: The purpose of this hange Request (R) is to announce the award of the A/B A Jurisdiction 15 contract to igna Government ervices (G) Administrators, LL for the administration of edicare Part A and Part B ee-for-ervice () claims, as well as the ome ealth & ospice (&) Region B service area. TIV AT: eptember 17, 2015 *Unless otherwise specified, the effective date is the date of service. IPLNTATION AT: arch 1, 2016 isclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any 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. II. ANG IN ANUAL INTRUTION: (N/A if manual is not updated) R=RVI, N=NW, =LT-Only One Per Row. R/N/ N/A APTR / TION / UBTION / TITL N/A III. UNING: or edicare Administrative ontractors (As): The edicare Administrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the A tatement of Work. 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. If 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 e-mail, and request formal directions regarding continued performance requirements. IV. ATTANT: One Time Notification
Attachment - One-Time Notification Pub. 100-20 Transmittal: 1600 ate: January 29, 2016 hange Request: 9456 UBJT: Award of edicare Administrative ontractor (A) ontract for Jurisdiction 15 TIV AT: eptember 17, 2015 *Unless otherwise specified, the effective date is the date of service. IPLNTATION AT: arch 1, 2016 I. GNRAL INORATION A. Background: On eptember 17, 2015, the enters for edicare & edicaid ervices () awarded the A/B A Jurisdiction 15 contract to G Administrators, LL for the administration of edicare Part A and Part B ee-for-ervice () claims in the tates of Kentucky and Ohio, as well as the ome ealth & ospice (&) Region B service area of olorado, elaware, Iowa, Kansas, aryland, issouri, ontana, Nebraska, North akota, Pennsylvania, outh akota, Utah,Virginia, West Virginia, Wyoming and the istrict of olumbia. As G Administrators, LL is the incumbent contractor for this A Jurisdiction, the current A workload numbers shall remain the same. G Administrators, LL shall perform this contract work at their current address of Two Vantage Way, Nashville, TN, 37228. The following applications or business owners shall continue to accept G' existing A workload numbers. Administrative Qualified Independent ontractor (AdQI), Analysis, Reporting and Tracking ystem ( ART), ontractor Administrative Budget and inancial anagement (A) ystem, omprehensive rror Rate Testing (RT) Program, ontractor anagement Information ystem (I), Baltimore ata enter (B), oordination of Benefits Agreement (OBA) Program, oordination of Benefits ontractor (OB), ontractor Reporting of Operational Workload ata (ROW) ystem, ommon Working ile (W), ustomer ervice Assessment and anagement ystem (A), ebt ollection ystem (), lectronic orrespondence Referral ystem (R),
lectronic ealth Records (Rs) Program, xpert laims Processing ystem (P), iscal Intermediary hared ystem (I), raud Prevention ystem (P) ealth are Information ystem (I), ealth are Integrated General Ledger Accounting ystem (IGLA), ealth Insurance aster Record (IR), ealth Insurance Portability & Accountability Act (IPAA) ligibility Transaction ystem (T), Integrated ata Repository (IR), Intern and Resident Information ystem (IRI), Local overage etermination (L) atabase, edicare Appeals ystem (A), edicare overage ata Base (), edicare econdary Payer Recovery ontractor (PR), ulti-arrier ystem (), National ata Warehouse (NW), National Level Repository (NLR), National Part B Pricing iles, National Provider Identifier (NPI) rosswalk, Next Generation esktop (NG), Part B Analytics Reporting (PBAR) ystem, Production Performance onitoring ystem (PUL), Provider nrollment hain and Ownership ystem (PO), Provider ustomer ervice Program ontractor Information atabase (PI), Provider Inquiry valuation ystem (PI), Program Integrity anagement Reporting (PIR) ystem, Program afeguard ontractor (P),
Provider tatistical and Reimbursement (P&R) ystem, Qualified Independent ontractor (QI), Quality Information valuation ystem (QI), Recovery Auditors (RA), Recover anagement and Accounting ystem (RA), Renal anagement Information ystem (RI), ystem Tracking for Audit and Reimbursement (TAR), Virtual ata enters (Vs), ZIP ode ile, and Zone Program Integrity ontractors (ZPIs). B. Policy: edicare Prescription rug Improvement and odernization Act of 2003, ection 911. II. BUIN RQUIRNT TABL "hall" denotes a mandatory requirement, and "should" denotes an optional requirement. Number Requirement Responsibility A/B A hared- ystem aintainers 9456.1 The J-15 A shall continue to utilize the current A workload numbers as follows; A B A I V W Other 15101 for the tate of Kentucky; 15201 for the tate of Ohio. 9456.2 The J-15 A shall continue to utilize the current A workload number of 15004 for & Region B service area. 9456.3 The J-15 A shall continue to utilize the current roll-up number/payer I 15001 for the tate of Kentucky, Ohio and & claims. 9456.4 The J-15 A shall continue to utilize the current A workload numbers as follows; 15102 for the tate of Kentucky; 15202 for the tate of Ohio. 9456.5 All applications and business owners that All
Number Requirement Responsibility A/B A hared- ystem aintainers currently utilize the workload numbers listed in the previous requirements shall continue to accept and utilize those workload numbers following the effective date of the J-15 A/B A contract. 9456.6 As of the effective date of the new J-15 A/B A contract, the J-15 A/B A shall track and charge all costs related to that contract to the appropriate ontract Line Item Number (LIN) as instructed by. A B A I V W Other applications and business owners listed in the background section of this R. 9456.7 The J-15 A shall continue to utilize the current roll-up number/payer I 15002 for the tates of Kentucky and Ohio claims. III. PROVIR UATION TABL Number Requirement Responsibility None A/B A A B A I IV. UPPORTING INORATION ection A: Recommendations and supporting information associated with listed requirements: "hould" denotes a recommendation. -Ref Requirement Number Recommendations or other supporting information: ection B: All other recommendations and supporting information: N/A V. ONTAT Pre-Implementation ontact(s): Jamie cleod, 415-744-3577 or robert.mcleod@cms.hhs.gov
Post-Implementation ontact(s): ontact your ontracting Officer's Representative (OR). VI. UNING ection A: or edicare Administrative ontractors (As): The edicare Administrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the A tatement of Work. 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. If 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 e-mail, and request formal directions regarding continued performance requirements. ATTANT: 0