Presentation to North Carolina Hospital Association Members

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Presentation to North Carolina Hospital
Association Members
Medicare Part A Fiscal Intermediary for the
State of North Carolina

• Durham

• Columbia

Presented by
Palmetto GBA
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Agenda

• Company Overview
• Transition Experience
• Transition Approach
• Current Status
• Post Transition Activities
• Electronic Data Interchange (EDI)

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Company OverviewBCBSSC

• Blue Cross and Blue Shield of South Carolina
• Employs 11,500
• 18 significant sites
• 10 South Carolina
• 3 Texas
• 1 Florida
• 1 Illinois
• 1 Maryland
• 1 Virginia
• 1 Georgia

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Company OverviewBCBSSC

• Medicare
• Palmetto GBA, LLC
• Trailblazer Health Enterprises, LLC
• Tricenturion, LLC
• TRICARE
• Medicaid
• Numerous other subsidiaries

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Company OverviewPalmetto GBA

• Wholly owned subsidiary of BCBSSC
• Solely devoted to government programs contracting
  activity
• Headquartered in Columbia, SC
• Offices in Florida, Illinois, and Georgia
• 2,000 employees
• Full time field staff in 14 states

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Company OverviewPalmetto GBA

• 30 years Medicare experience
• One of nations largest and most diverse Medicare
  contractors
• Extensive experience with
• Contract and workload implementations
• Multi-state service areas
• Turnkey transitions
• Processing Medicare Part A claims

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(No Transcript)
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Statistical Analysis DMERC (1993)
USA
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Transition Experience

• Core competency of our organization
• Successfully executed 3 turnkey Medicare
  transitions in the past 4 years
• Aetna-Clearwater field office, 1997
• Trailblazer Health Enterprises, 2000
• Railroad Retirement Medicare, 2000
• In all 3, data center moves created greater
  complexities

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Transition Experience

• Southeast Regional Home Health Intermediary
  (RHHI)
• Four states
• Transitioned from BCBSTN, NC, and KY in 1986
• Durable Medical Equipment Regional Carrier (DMERC
  Region C)
• 16 states and territories
• Transitioned from 15 separate carriers in 1993

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Transition Experience

• Southwest RHHI
• Five states
• Transitioned from BCBSNM in 1986
• Gulf Coast RHHI
• Four states
• Transitioned from Aetna in 1997
• Included APASS to FISS conversion

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Transition Experience

• Midwest RHHI
• Three states
• Transitioned from Healthcare Services Corp 1998
• Railroad Medicare Carrier
• National
• Transitioned from United Health Care Group 2000

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Transition Experience

• Over 20 other transitions/implementations in the
  last 15 years
• Predominantly Medicare related
• Other government programs
• TRICARE
• Medicaid

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Transition Approach

• Turnkey
• Continue existing operations in Durham
• Name change only
• Retain current
• Staff
• Facility and contents
• Toll free telephone numbers and addresses
• APASS processing system
• ARBCBS data center

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Transition Approach

• Extended EDI Transition
• Four month window
• Early Boarding option
• Communications
• Press releases/media outlets
• Mailings
• Workshops

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Transition Approach

• Communications, continued
• Notify/work with
• NC Hospital Association
• Other associations/trade groups
• Senior and health groups
• NC Part B carrier (CIGNA)
• Peer Review Organization (MRNC)

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Transition Approach

• Communications, continued
• Notify/work with
• State Health Insurance Assistance Program (SHIP)
• AARP offices
• Social Security offices
• Councils on aging
• Congressional offices

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Transition Approach

• Communications, continued
• Mailings
• Introductory letter
• EDI instructions
• Transition hot line
• 803-763-4440
• Web site
• www.PalmettoGBA.com

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Transition Approach

• Workshop Schedule
• 10/01/01 Charlotte
• 10/04/01 Chapel Hill
• 10/15/01 Charlotte
• 10/16/01 Asheville
• 10/18/01 Chapel Hill
• 10/22/01 Wilmington

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Transition Approach

• Workshops
• Full day sessions
• Variety of management and staff
• All providers invited
• Cahaba Benefits Administrators (CBS)
  participating
• Interactive on line workshop option to be offered

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Transition Approach

• Operational due diligence
• Understand processes and procedures
• Learn control environments
• Establish relationships
• Identify issues/concerns
• Do not intend to change policies/ procedures
  during transition period

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Transition Approach

• Facilities
• Lease existing Duke St building
• Acquire assets and equipment leases
• Establish connectivity to SC network
• Personnel
• Recruit and offer employment to existing Medicare
  staff

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Transition Approach

• Cutover
• Targeting weekend of October 26-29
• Assume control of office
• Make system updates
• Verify output
• Palmetto GBA FI effective October 29
• FI - Fiscal Intermediary
• PM - Program Management
• AC - Affiliated Contractor

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Transition ApproachWorking with the PSC

• Coordinate closely with the Program Safeguards
  Contractor (PSC)
• Develop joint operating agreement (JOA)
• Focus on team work
• Define operational details
• establish service levels
• Coordinate education and publications
• consolidated Medicare bulletin

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Current Status

• Facility lease drafted
• Asset inventory completed
• Employment applications collected
• Offers being extended this week
• Connectivity to SC established
• Transition hot line established
• Workshops scheduled

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Current Status

• Introductory letter mailed
• EDI package prepared
• Initial meeting with NCHA conducted
• On site meetings in NC conducted

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Post Transition Activities

• Monitor pending workloads
• Monitor cash flow
• Evaluate work group needs
• Business as usual
• Same staff
• Same desk
• Same system

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Contacts

• During transition
• Same toll free telephone number you usually
  contact
• Same NC FI staff you usually contact
• Same NC Medicare web site
• Transition hot line 803-763-4440
• www.PalmettoGBA.com
• After transition
• Same toll free telephone number
• Same NC FI staff
• www.PalmettoGBA.com

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Transition Schedule

• September 4, 2001
• Providers can begin sending completed EDI
  enrollments to Palmetto GBA
• September 10, 2001
• Early Boarding providers can begin submitting
  claims to Palmetto GBA.
• DDE users can begin accessing APASS through AGNS.
  Any claims received by Palmetto GBA will be
  automatically forwarded to BCBSNC.

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Transition Schedule

• October 20, 2001
• Last date for Palmetto GBA to receive EFT
  Authorization Forms
• October 26-29, 2001
• Palmetto GBA becomes the North Carolina Part A
  Fiscal Intermediary.
• October 29, 2001
• Claims submissions to BCBSNC will be
  automatically forwarded to Palmetto GBA

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Transition Schedule

• December 31, 2001
• BCBSNC will discontinue accepting Medicare Part A
  claims and discontinue access to APASS. At this
  time, all claims must be submitted to Palmetto
  GBA. And all access to APASS will be through the
  AGNS network.

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NC EDI Transition
Current EDI Network
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NC EDI Transition
EDI Transition Network - 9/1 - 12/31
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NC EDI Transition
Ongoing EDI Network
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Important Items

• Packet mailed to all Providers
• Early Boarding
• Extended Window
• Batch Submissions and Retrieval
• DDE/Blue E
• EFT
• EDI Enrollment Requirements
• HIPAA
• Vendors

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Early Boarding

• Providers must switch submissions of claims and
  related transactions to Palmetto GBAs EDI
  Network
• Providers can switch submissions now as soon as
  enrollments received and processed.
• This includes all batch submissions of claims and
  retrieval of Remittances
• Claims will be forwarded automatically to NC
  Medicare Claims System (APASS)

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Extended Window

• To minimize impact and provide additional time to
  work out changes, Providers can continue to send
  submissions of claims and related transactions to
  BCBSNCs EDI network until 12/31/01.
• This includes all batch submissions of claims and
  retrieval of Remittances
• Claims will be forwarded automatically to SC
  Medicare Claims System (APASS) after 10/26/01

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Extended Window

• Options are provided to allow time to work
  through problems and issues.
• Do not wait until last minute to start.
• Switch networks as soon as possible!!

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Batch Submissions

• September 4th packet includes communications
  specifications (Enclosure 1).
• EDI network accepts and processes UB92 6.0 -
  provides real-time response
• EDI network modified to accept local proprietary
  format - next day response
• ERA will be same format as currently received

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DDE/Blue E

• Blue E functionality differences
• Must key claims into APASS instead of Blue e.
• Medicare Part A only
• Business Decision required by Providers
• APASS userids to remain the same
• Can continue to use Blue e until 12/31/01

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DDE/Blue E

• Dial connectivity through AGNS
• Complete (Enclosure 3)
• On-line services new user worksheet
• ATT Global Network Services Order Form
• Statement of Understanding of Charges
• EDI Enrollment Form (Enclosure 5)
• Upon receipt, we will return to you network
  userids, software, and instructions

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DDE/Blue E

• Leased Line Connectivity through AGNS
• Complete (Enclosure 4)
• Design Questions
• ATT Service Provider Agreement
• EDI Enrollment Form (Enclosure 5)
• Upon receipt, we will place order for your
  circuit and provide back to you an expected
  install date, userids, and software.

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DDE/Blue E

• Leased Line Connectivity through AGNS
• Install charges waived by ATT if order received
  by Palmetto GBA by 10/1/01!
• Please note If you already have an ATT MDNS
  circuit, it can be utilized and no new circuit
  required. Contact the EDI help line.

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EFT

• EFT will continue uninterrupted
• Providers must complete Authorization to
  Continue Electronic Funds Transfer form
  (Enclosure 6)
• Make sure to get in on time

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EDI Enrollment Requirements
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HIPAA

• Currently distributing specifications and
  testing/compliance requirements to Palmetto GBA
  providers.
• Will provide to NC providers after transition

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Vendors

• All vendors received communications along with
  providers.
• We are specifically contacting key vendors based
  on recommendations from BCBSNC
• HDX eligibility systems not impacted

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Final Tip

• EDI Help Line number
• 866-749-4301
• Identify yourself as a NC Part A Provider
• E-mail medicare.edi_at_PalmettoGBA.com
• Website www.PalmettoGBA.com

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We look forward to working with you!

• Durham

• Thank You

• Columbia

Presented by
Palmetto GBA