Important Information Regarding the J1 Part A EDI Transition.

Attend J1 WPS Transition ACT calls.

Letter to J1 WPS Transition Providers

To:  Providers formerly serviced by Mutual of Omaha, now serviced by Wisconsin Physicians Service

From: J1 A/B MAC Team at Palmetto GBA

Effective April 19, 2010, most WPS providers located in California, Nevada, Hawaii, Guam, American Samoa and the Northern Mariana Islands will transition to Palmetto GBA for all:

• Claims Processing
• Provider Enrollment activities
• Provider Audit and Reimbursement activities
• Customer Service via the Provider Contact Center
• Redetermination requests (first level appeals)
• Education needs of the Provider community

This change is being made at the direction of the Centers for Medicare & Medicaid Services (CMS) and is consistent with a regulation which requires that most providers be assigned to Medicare Administrative Contractors based on their geographic location.

A limited subset of Medicare chain providers in these states, known as 'qualified chain providers' (QCPs), may not be transferred to the J1 A/B MAC in order to facilitate the chain’s ability to bill only one MAC. If you are a hospital (including a critical access hospital) or skilled nursing facility within the areas listed above and are a member of a chain, check with your home office to determine if the chain has received a QCP approval letter from CMS.

Palmetto GBA is actively coordinating the transition with WPS. WPS will make every effort to ensure that providers continue to receive quality Medicare services during the transition period.

Palmetto GBA is committed to the CMS’s fundamental goal of giving health care providers the necessary tools and resources to submit claims correctly. We are also committed to delivering the information they need to understand the Medicare program, and inform them early and often about changes.

To that end, Palmetto GBA has created two resources to assist the WPS providers in their transition to Palmetto GBA. A Web site dedicated to assisting WPS providers with questions about the transition and Palmetto GBA. To visit this page again, you may use this shortcut URL, www.palmettogba.com/J1WPS.

We hope this Web site will help make your transition to Palmetto GBA as smooth as possible without any disruption of service. Please visit often until the April 19, 2010, cutover date for the latest updates about the transition.

Right Now:
Please review our Frequently Asked Questions about:

• Appeals
• Audit/Reimbursement
• Electronic Data Interchange
• Electronic Funds Transfer
• Medical Affairs and Local Coverage Determinations 
• Medical Review
• Provider Enrollment
• Provider Outreach and Education

Coming Soon:

• Register for our transition listserv. In addition to this Web site, the listserv will be the best form of information about the transition. You’ll receive e-mail messages notifying you about upcoming deadlines and policy or coverage changes.
• Look out for our convenient transition checklist so you can make sure your membership and claims are transferred quickly
• E-mail us any questions at our e-mail hotline especially for WPS legacy providers
• Helpful hints for how to find and search for information on www.palmettogba.com
• Participate in monthly Ask the Contractor Teleconferences (ACTs) on specific topics

Note: This Web site is for providers who are transitioning from Wisconsin Physicians Service to Palmetto GBA J1 Part A. If you are already a J1 Part A or B provider, please visit our Web site.

Palmetto GBA will:

• Provide consistent, open and clear communication through multiple channels about changes you can expect and key dates
• Ensure the same high levels of service you have experienced from your existing FIs and carriers
• Remain committed to establishing and maintaining partnerships with key medical and professional associations, health care entities, providers and provider groups
• Continuously and tirelessly work with you to minimize or eliminate any disruptions in your business with Medicare
• Our primary goal is to manage this transition seamlessly