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Noridian JE Implementation Website Launch

Mon, 2013-05-20 12:38

Noridian is the new Medicare Administrative Contractor (MAC) for Jurisdiction E (JE) – formerly Jurisdiction 1; California, Hawaii, Nevada (transition date 9/16/2013). As they begin the process of implementing the JE workload, they want to inform you of important changes that may impact you. Their objective is to make the fewest changes possible in order to allow for a smooth implementation. Noridian will continue to be adding many more features and articles in the coming weeks to the website.

NAS Changes Name to Noridian Healthcare Solutions (Noridian)

Mon, 2013-05-20 12:35

Effective May 13, 2013 Noridian Administrative Services (NAS) has officially changed its name to Noridian Healthcare Solutions (Noridian) to better reflect the scope of capabilities that have grown from their core business.

MAC JF for Arizona, Alaska, Idaho, Oregon, Montana, North Dakota, South Dakota, Utah, Washington, Wyoming for Part B  and Minnesota for Part A. Future MAC JE for California, Hawaii and Nevada.

Palmetto MoPath Claims Submission Guidelines

Mon, 2013-05-20 12:26

Because the MoPath Tier 2 CPT code descriptions do NOT identify the specific genes tested, laboratory providers that have not obtained a unique 5-digit ID through Palmetto GBA or McKesson Dex must provide additional information until an ID is obtained. As per the MolDx Program, claims submitted in J1 without a unique ID will be denied. Claims submitted in all other areas administered through Palmetto GBA should reference the “Required Text,” Column 3, to submit the information required for claim reimbursement. Column 3 “Required Text” lists key components needed to adjudicate the claim.

Palmetto J1 Loses Protest for Medicare Contract

Thu, 2013-02-28 11:56

On January 18, 2013, the Government Accountability Office (GAO) announced that they denied Palmetto’s protest, awarding the Medicare contract for Jurisdiction E (previously referred to as J1) to Noridian Administrative Services. On September 20, 2012, CMS announced that Noridian Administrative Services (NAS) had been awarded the contract for the administration of Medicare Part A and Part B fee-for-service claims in A/B MAC Jurisdiction E, which was previously called Jurisdiction 1.

Palmetto J1 2013 MoPath Fee Schedule

Thu, 2013-02-28 11:52

Palmetto GBA has determined a gapfill allowance for the 2013 MoPath CPT codes. The fees were based on the detailed analysis of multiple lab applications and a standardization of the submitted stacks. All services to produce the assay result, including the work for microdissection, were evaluated and included in the listed fee. Therefore, additional services should not be submitted in addition to the appropriate CPT code for your assay. Palmetto has also included the coverage determination established during the review of available literature.

Palmetto J1 88305 Prostate Biopsy Frequency denying incorrectly

Thu, 2013-02-28 11:40

Claims submitted with CPT 88305 for Prostate Biopsy Frequency were denying incorrectly. The claims affected were processed on 11/14/2012 for dates of service on or after 1/1/2012. The issue has been resolved on 1/22/2013 with mass adjustments to the affected claims completed on 1/10/2013.

Medicare Part A and Part B MAC for Jurisdiction 11; comprised of North Carolina, South Carolina, Virginia and West Virginia. Medicare Part A and Part B MAC for Jurisdiction 1; comprised of California, Hawaii and Nevada.

Palmetto J1/J11: New Feature! Part B Claims Processing Issues Log (CPIL)

Thu, 2013-02-28 11:37

Palmetto GBA is pleased to announce the implementation of their new Claims Processing Issues Log (CPIL). The log lists current system-related claims processing issues. These issues have been reported to CMS and/or the Multi-Carrier System (MCS). This new option will conveniently allow you to research major issues affecting the provider community before contacting the provider contact center. The issues are identified by stand alone articles and will be updated as needed.

Palmetto J11 Molecular Diagnostic CPT Codes Claim Submission Guidelines

Thu, 2013-02-28 11:33

Effective immediately, Palmetto J11 will require lab providers that submit claims for Molecular Diagnostic CPT codes, to include additional documentation so they can identify the provided service. For services that require more than one claim line, the additional information must appear on each line used to report the service. Additional information may be entered in the comment/narrative field. This information will be used to determine the price and the coverage for the service. If available, lab service providers may use the MolDx ID for the specific test.

MolDx: 2013 HCPCS and CPT Code Changes

Wed, 2012-12-19 14:19

Effective for services performed on or after January 1, 2013, the following codes will be included in the MolDx code range and will require a unique identifier for each claim line submission:

Code Category/Description

2013 MolDx CPT Code Range

Comment

MolDx: Web Page Search Tool

Wed, 2012-12-19 14:16

To facilitate your MolDx information search, Palmetto GBA has added a search tool and two new topics to help you find the MolDx information you need.

Palmetto GBA

Medicare Part A and Part B MAC for Jurisdiction 11; comprised of North Carolina, South Carolina, Virginia and West Virginia. Medicare Part A and Part B MAC for Jurisdiction 1; comprised of California, Hawaii and Nevada.

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