DMAC A&B Transition July 1; Delays in C&D

O&P providers in Regions A and B will not be able to check status of claims or appeals from June 28-30, due to transitions from the previous Durable Medical Equipment Regional Carriers (DMERCs) to the new DME Medicare Administrative Contractors (DMACs), according an alert issued by the American Orthotic & Prosthetic Association (AOPA). The transition date is July 1.

AOPA recommends that providers plan ahead to get all claims and appeals questions answered before June 28.

Region A will change contractors from HealthNow to the National Heritage Insurance Company (NHIC) on July 1, notes the National Association for the Advancement of Orthotics (NAAOP) at www.naaop.org

The Region B contractor is AdminaStar Federal.

There is not much change in area covered by the new Jurisdictions A and B from the previous DMERC Regions A and B. Providers in Maryland and District of Columbia (DC) will go from Region B to Region A. Providers in Kentucky will change from Region C to Region B.

Transitions in Regions (Jurisdictions) C and D have been delayed, due to protests from CIGNA Government Services filed with the Government Accounting Office (GAO) in January regarding contracts awarded for Region C to Palmetto GBA and Region D to Noridian Administrative Services.

The GAO denied CIGNA's protest regarding the Noridian contract May 4, and so the Centers for Medicare & Medicaid Services (CMS) has authorized Noridian to resume work under Jurisdiction D as of May 8 and expects Noridian to be able to assume full responsibilities for Jurisdiction D before the end of 2006, CMS stated.

GAO sustained CIGNA's protest regarding Jurisdiction C and recommended corrective steps. In response to the recommendations of GAO, on May 10 CMS reopened discussions with the offerors within the competitive range in this procurement for Jurisdiction C, CMS explained. CMS requested that the competitive range offerors submit Final Proposal Revisions "which will be evaluated consistent with the provisions of the solicitation." At the current time, no transition activity is occurring with respect to the DME MAC for Jurisdiction C, nor is there any activity with respect to implementing the four contract options," according to CMS May 16.

Also affected are the four other contracts awarded to Palmetto GBA: those for the Medicare Electronic Data Interchange System (MEDIS), the Data Center, the National Supplier Clearinghouse (NSC) and Data Analysis and Coding (DAC). The latter is like the current SADMERC.

These will not be implemented on July 1, explains NAAOP. Instead, Palmetto will continue under its current SADMERC and NSC contracts. Because the MEDIS contract has been stayed, O&P providers will continue to send their claims to their respective DMERCs/DMACs, rather than to a centralized MEDIS, according to NAAOP.

For more information, visit the CMS website: www.cms.hhs.gov/MedicareContractingReform/ and click on the left-hand side button for "Durable Medical Equipment Administrative Contractor"

Other sources are NAAOP at www.naaop.org and AOPA at www.aopanet.org

DMAC A&B Transition July 1; Delays in C&D

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