This communication should be read by ALL practices located in Colorado, New Mexico, Oklahoma and Texas. 
Practices located in states not listed are not affected by this change in fiscal intermediary. 

This will cover the affect this change in fiscal intermediary will have on claims if you process them through a clearinghouse, such as Ingenix (ENS) or RelayHealth.
Your action items will vary depending on whether you submit claims via Print Image or ANSI, and which clearinghouse you use.

Paper Claim Submission Address

At this time Novitas Solutions is not listing a PO Box for claim submission in Colorado, New Mexico, Oklahoma and Texas.  When that information is available, we will communicate that to all clients.

Print Image 

If you send claims via Print Image, there is no action needed on your part. Your clearinghouse will handle any changes needed.  Note that this item applies to 75% of our clients as they submit claims via Print Image. 

How do I know I am sending claims via Print Image?  In Medisoft go to the “List” menu and select “EDI Receivers”.  When the receiver list opens, double click on the receiver you are using (usually named “ENS” or “EDI” or “EDSS”) to edit.  Click on the “ID” tab and locate the “Program File” field.  If the entry in that field contains the words “CMSFile” or “CMS11”, you are preparing your electronic file via Print Image. 

 

ANSI

If you are preparing and sending claims in ANSI format, you may or may not need to take action, depending on the clearinghouse you are using.  The Claims Payer ID will change as follows:

The Claims Payer ID is stored in Medisoft in the insurance carrier screen, List>Insurance>Carriers.  Locate your Medicare carrier and double click to edit.  Click on the “EDI/Eligibility” tab.

Each clearinghouse manages the Payer ID differently, so your action will vary depending on your clearinghouse.

Ingenix/ENS

If you are processing claims through Ingenix (ENS) , there is no action needed on your part.  The payer Payer ID is COMCR.  At the time of cutover, they will handle placing the correct Payer ID on the outbound claims.  

RelayHealth

I have researched RelayHealth’s web site and can find no information on whether the Claims Payor ID (CPID) will change at cutover.  We suspect the CPID will change at cutover however.  We will monitor this and report to our clients as soon as we have information.

All Other Clearinghouses

There are over a dozen clearinghouses that our clients use, making it very difficult to research all the combinations.  We strongly recommend that you monitor messages from you clearinghouse and take the appropriate action.

If you do need to change the Payer ID, you can do that by going to the “List” menu in Medisoft, click on “Insurance” then “Carrier”.  Locate your Medicare carrier then double click on the “EDI/Eligibility” tab.  In the “Claims Payer ID” field, make the change instructed by your clearinghouse and click on “Save”.  This should be the only change you will need to make. 

If you have any questions regarding this information please e-mail us at helpdesk@mdsco.com.