anual ystem Pub 100-20 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.
ttachment One-Time Notification Pub. 100-20 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, 2007. 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 0 5 2 0 1 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 0 5 2 0 2 K Jurisdiction tate Used in laim tate ndicator Part 1
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 0 5 0 0 1 Jurisdiction indicator Part (oll-up) Number laim Type* 0 5 0 0 2 Jurisdiction indicator Number laim Type* 1 8 0 0 3 Jurisdiction indicator Number laim Type* 0 6 0 0 4 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 0 5 0 0 0 Number Table: Jurisdiction 5 Jurisdiction Number 05000 Part /Part 05001 05002 (oll-up) Number 2
Workload Number owa 05101 05102 Kansas 05201 K 05202 K issouri 05301 O 05302 O Nebraska 05401 N 05402 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 01101 6/01/08 01201 01001 6/01/08 1 2 01301 NV 6/01/08 01102 5/01/08 01202 01002 2/01/08 01302 NV 2/0108 02101 K 2/01/08 02201 5/01/08 02001 02301 O 5/01/08 02401 W 2/01/08 02102 K 2/01/08 02202 5/01/08 02002 02302 O 2/01/08 02402 W 2/01/08 03101 Z ompleted 3 4 03201 T ompleted 03301 N 03001 ompleted 03401 ompleted 03501 UT ompleted 03601 WY ompleted 03102 Z ompleted 03202 T ompleted 03302 N ompleted 03002 03402 ompleted 03502 UT ompleted 03602 WY ompleted 04101 O 5/01/08 04201 N 5/01/08 04001 04301 OK 3/01/08 04401 TX 5/01/08 04102 O 04002 2/01/08 04202 N 3/01/08 04302 OK 3/01/08 3
Jurisdiction Workload Type Workload Number tate oll- up 5 6 7 8 9 10 11 arliest llowable ut over ate 04402 TX 5/01/08 05101 5/01/08 05201 K 3/01/08 05001 05301 O 5/01/08 05401 N 12/01/07 05102 2/01/08 05202 K 3/01/08 05002 05302 O 3/01/08 05402 N 3/01/08 06101 L 3/01/09 06201 N 06001 06301 W 3/01/09 06102 L 06202 N 06002 06302 W 07101 2/01/08 07201 L 07001 3/01/08 07301 3/01/08 07102 2/01/08 07202 L 07002 2/01/08 07302 5/01/08 08101 N 3/01/09 08001 08201 08102 N 3/01/09 08002 08202 09101 L 3/01/09 09001 09201 P/V 09102 L 3/01/09 09002 09202 P/V 10101 L 2/01/09 10201 G 10001 10301 TN 3/01/09 10102 L 2/01/09 10202 G 10002 2/01/09 10302 TN 3/01/09 11101 N 11201 11001 11301 V 12/01/08 11401 WV 12/01/08 11102 N 11002 3/01/09 4
Jurisdiction Workload Type Workload Number tate oll- up 12 13 14 arliest llowable ut over ate 11202 11302 V 3/01/09 11402 WV 12101 6/01/08 12201 2/01/08 12301 12001 2/01/08 12401 NJ 2/01/08 12501 P 2/01/08 12102 6/01/08 12202 6/01/08 12302 12002 6/01/08 12402 NJ 5/01/08 12502 P 5/01/08 13101 T 6/01/08 13001 13201 NY 6/01/08 13102 T 5/01/08 13002 13202 NY 3/01/08 14101 3/01/09 14201 3/01/09 14301 N 14001 3/01/09 14401 2/01/09 14501 VT 3/01/09 14102 14202 14302 N 14002 14402 2/01/09 14502 VT 15101 KY 6/01/09 15001 15201 O 6/01/09 15 15102 KY 6/01/09 15002 15202 O 16003 00811 completed 17003 00635 completed 18003 00885 completed 19003 05655 completed ome ealth and ospice 6 06004 K 12/01/08 11 11004 L 12/01/08 14 14004 T 12/01/08 15 15004 L 3/01/09 5
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) 5651.1 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. 5651.1.1 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. 5651.2 shall be modified to reflect the new 5651.3 T shall be modified to reflect the new 5651.4 shall be modified to reflect the new 5651.5 OW shall be modified to reflect the new 5651.6 and P shall be modified to reflect the new 5651.7 shall be modified to reflect the new 5651.8 shall be modified to reflect the new 5651.9 NP rosswalk ontractor shall modify the system to accept the new contractor number. 5651.10 PaT shall be modified to reflect the new 5651.11 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 5651.12 P shall be modified to reflect the new P NG 6
Number equirement esponsibility (place an X in each applicable column) 5651.13 PO shall be modified to reflect the new 5651.14 PUL shall be modified to reflect the new 5651.15 shall be modified to reflect the new 5651.16 shall be modified to reflect the new 5651.17 atamatch files for the workload shall be sent on separate files from the Part workload to the appropriate contractor. 5651.18 VP shall modify uperop with the new contractor number as appropriate. 5651.19 O/O shall be modified to reflect the new 5651.20 The individual Ps shall make any necessary modifications if needed to reflect the new 5651.21 LOL shall be modified to reflect the new 5651.22 T shall be modified to reflect the new 5651.23 shall be modified to reflect the new 5651.24 shall be modified to reflect the new 5651.25 ll free billing software shall be upgraded to reflect the new 5651.26 PO shall be modified to reflect the new 5651.27 Quality all onitoring shall be modified to reflect the new 5651.28 PO shall be modified to reflect the new contractor number 5651.29 O shall be modified to reflect the new 5651.30 The ontractor shall work with the to modify its records to reflect the new 5651.31 P& shall be modified to reflect the new contractor number 5651.32 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
Number equirement esponsibility (place an X in each applicable column) shall be modified to reflect the new 5651.33 shall be modified to reflect the new contractor number 5651.34 W shall be modified to reflect the new contractor number 5651.35 GL can use the contractor number or rollup number or in certain situations not use either number 5651.36 W LG module shall be modified to reflect the new contractor number 5651.37 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) 5651.38 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
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): dward.lain@cms.hhs.gov or 410-786-0848 or Ken.arshall@cms.hhs.gov or 410-786-3318 Post-mplementation ontact(s): dward.lain@cms.hhs.gov or 410-786-0848 or Ken.arshall@cms.hhs.gov or 410-786-3318 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 e-mail, and request formal directions regarding continued performance requirements. or Title XV contractors: N.. 9