Highmark Now Novitas

Part A/B Medicare administrative contractor (MAC) Highmark Medicare Services (HMS) is now Novitas Solutions, Inc. Along with the name change, providers in the new jurisdiction H may have to update their electronic funds transfer (EFT) paperwork and their understanding of local coverage determinations (LCDs).

Novitas will process Medicare fee-for-service (FFS) claims and other administrative services for hospitals and other institutional providers, physicians, and health care practitioners in Louisiana, Arkansas, Mississippi, Texas, Oklahoma, Colorado, and New Mexico under jurisdiction H (JH). Novitas will also process Indian Health Service facility claims for the entire country and serve as the designated A/B MAC to support centralized billing for mass immunizers.

Novitas will continue to serve as the Part A/B MAC for jurisdiction 12 (J12), which includes Delaware, New Jersey, Pennsylvania, Maryland, and the District of Columbia, as well as the counties of Arlington and Fairfax and the city of Alexandria in Virginia, for Part B until it transitions to JH.

The Centers for Medicare & Medicaid Services (CMS) is forming JH by consolidating A/B MAC jurisdictions 4 and 7. This change reflects the CMS MAC jurisdiction strategy, announced in 2010, to consolidate from 15 Part A/B MAC jurisdictions to 10 by 2016.

Over the next several months, CMS will oversee the transfer of Medicare work from the incumbent contractors noted below to Novitas:

  • TrailBlazer Health Enterprises is the incumbent contractor for A/B MAC Jurisdiction 4 (Colorado, New Mexico, Oklahoma, and Texas).
  • Pinnacle Business Solutions holds the Part A fiscal intermediary (FI) contracts for Arkansas, Louisiana, and Mississippi.
  • Pinnacle also holds the Part B carrier contracts for Arkansas and Louisiana.
  • Cahaba Government Benefits Administrators®, LLC, holds the Part B carrier contract for Mississippi.

Cutover dates are:

Arkansas, Louisiana (Part B) – Aug. 13
Arkansas, Louisiana, Mississippi (Part A) – Aug. 20
Mississippi (Part B) – Oct. 22
Colorado, New Mexico, Oklahoma, Texas, WPS Providers (Part A) – Oct. 29
Colorado, New Mexico, Oklahoma, Texas (Part B) – Nov. 19

Required Provider Action

Providers should continue to direct claims to their current contractors until one day prior to the appropriate cutover date, specified above.

Providers who are currently receiving Medicare payments electronically from their current contractor must submit a new CMS-588 EFT Authorization Agreement 05/10 version to Novitas (unless they have already submitted the 05/10 version of the EFT agreement to their current contractor and they submit a copy of the form to Novitas). Failure to update to the 05/10 version may result in a delay or interruption of your Medicare payments.

New JH LCDs will be posted to the Novitas website and the Medicare Coverage Database on June 28 for a minimum 45-day notice before becoming effective.

Providers should also notify their vendors, clearinghouses, and billing services of this name change to prevent any possible programming errors.

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