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Industry News: Trailblazer

TrailBlazer’s Web site offers Medicare Secondary Payer (MSP) information

Monday, May 02, 2011

Medicare Secondary Payer (MSP) is the term used by Medicare when another payer pays primary to Medicare. Currently, Medicare is secondary payer to beneficiaries covered for health care benefits through their Group Health Plan (GHP) or a spouse’s or family member’s GHP, disability, End Stage Renal Disease (ESRD), and for automobile, no-fault liability, Workers’ Compensation (WC), Veterans Affairs (VA) and Black Lung (BL) situations. Note: VA and other federal payments are exclusions rather than MSP non-payments.

Reason Code Search Tool
Tuesday, March 29, 2011

Medicare Part A and Part B MAC for Jurisdiction 14; comprised of Colorado, New Mexico, Oklahoma and Texas

Part B Virginia Providers – Implementation of A/B MAC Jurisdiction (J11)
Tuesday, March 01, 2011

On September 9, 2010, CMS announced that Palmetto GBA will begin implementation as the new Jurisdiction 11 (J11) A/B Medicare Administrative Contractor (A/B MAC), which includes the following states:

• North Carolina.
• South Carolina.
• Virginia.
• West Virginia.

Palmetto GBA will assume responsibility for the Part B Virginia J11 MAC operations March 19, 2011.

Electronic Funds Transfer (EFT) Agreements

Outpatient Diagnostic Testing for Ordering Physicians and Clinical Laboratories
Tuesday, March 01, 2011

TrailBlazer Health Enterprises
Medicare Part A and Part B MAC for Jurisdiction 14; comprised of Colorado, New Mexico, Oklahoma and Texas. Legacy Medicare Part B Virginia.

CMS Selects TrailBlazer Health Enterprises to Administer Medicare Program in Arkansas, Louisiana and Mississippi
Tuesday, January 26, 2010

On July 10, 2009, CMS awarded a new contract to TrailBlazer Health Enterprises, LLC to serve as the Medicare Administrative Contractor (MAC) for Jurisdiction 7, which includes Arkansas, Louisiana and Mississippi. The full period of contract performance is five years, including implementation, a base operations period and four available option years.

TrailBlazer already serves as the MAC for Jurisdiction 4, composed of Texas, Oklahoma, New Mexico and Colorado, and will begin implementing operations in the new service area immediately.

Orders for Diagnostic Testing
Wednesday, December 02, 2009

TrailBlazer Health Enterprises® - Carrier/FI for Colorado, New Mexico, Oklahoma, Texas and Virginia.

Due to the recent increase in the number of errors identified during the Comprehensive Error Rate Testing (CERT) contractor audit for the lack of physician orders for diagnostic tests, TrailBlazer recommends that providers sign all orders for testing and/or progress notes showing the intent for testing to be completed.

Documentation Signatures
Tuesday, November 24, 2009

As a reminder, the treating physician’s signature must be present in the documentation associated with all services submitted to Medicare. Medicare requires the signature be a legible identifier for the provided/ordered services.

NOTE: CMS Change Request 6100 clarifies that “ No signature is required on orders for clinical diagnostic tests paid on the basis of the clinical laboratory fee schedule, the physician fee schedule, or for physician pathology services.

Documentation Signatures
Tuesday, November 24, 2009

As a reminder, the treating physician’s signature must be present in the documentation associated with all services submitted to Medicare. Medicare requires the signature be a legible identifier for the provided/ordered services.

NOTE: CMS Change Request 6100 clarifies that “ No signature is required on orders for clinical diagnostic tests paid on the basis of the clinical laboratory fee schedule, the physician fee schedule, or for physician pathology services.

CERT Feedback Report Errors and Recommendations for Improvement
Tuesday, November 24, 2009

Of 200 claims sampled in the August 31, 2009, CERT Feedback Report, 136 errors were identified. Nearly half of errors identified in the August 31, 2009, CERT Feedback were a result of a lack of documentation of medical necessity. In addition, more than 36 percent of errors identified were a result of insufficient documentation.