Palmetto Receives Stop-Work Order for J11

Just two weeks after its award of the Part A and Part B Medicare Administrative Contractor (A/B MAC) contract for jurisdiction 11 and home health and hospice MAC for jurisdiction C, Palmetto GBA has received a stop-work order from the Centers for Medicare & Medicaid Services (CMS).

The action is due to a protest CIGNA Government Services (CGS) filed June 1 with the Government Accountability Office (GAO). The timely filing of the protest has triggered an automatic stay on performance pending the GAO’s decision, due no later than Sept. 9.

Palmetto GBA received the J11 contract award May 21 as a result of voluntary corrective action taken by CMS when the original award to Palmetto GBA in January 2009 was protested by another bidder.

Jurisdiction 11 is comprised of North Carolina, South Carolina, Virginia, and West Virginia. Jurisdiction C includes Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Texas.

The following legacy fiscal intermediaries (FIs) and carriers will continue to service providers in J11 and JC until further notice:

  • CGS (carrier for North Carolina)
  • National Government Services (NGS) (FI for Virginia and West Virginia)
  • Palmetto GBA (FI for North Carolina and South Carolina; carrier for South Carolina and West Virginia; RHHI for Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio Oklahoma, South Carolina, Tennessee, and Texas)
  • TrailBlazer Health Enterprises, LLC (carrier for Virginia)
  • Wisconsin Physicians Service Insurance Corp. (WPS) (FI for some providers in North Carolina, South Carolina, Virginia, and West Virginia)

Palmetto GBA is A/B MAC for J1 (California, Hawaii, and Nevada). On April 19, some providers serviced by WPS, formerly serviced by Mutual of Omaha, also transitioned to the J1 A/B MAC.

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