As many of you already know, Noridian has won the contract for what is now being called Jurisdiction E. This Jurisdiction, which includes CA, NV, HI, Guam, American Samoa and the Northern Mariana Islands, used to be served by Palmetto Medicare, but will be switching to Noridian at 5pm on September 16th for part B, and on August 26th for part A.
You have two options with this transition. You can opt to switch to a clearing house and let them take care of it for you as many are doing. If you would like to pursue this route we have negotiated special packages and rates with Gateway EDI, call us for more details. The other option is to switch to Noridian which we have outlined below.
Noridian is offering something called “early on boarding” to those clients who don’t want to make the switch with everyone else. If you contact Noridian at 1-800-361-8289 they will provide you a new user name and password, and a new dialup number to submit claims to. You can then start submitting to the new company and they will FORWARD your claims to Palmetto, and retrieve your mail from Palmetto for you.
Unfortunately, reports from the field have not been good. There have been reports of delays in claims processing of between 1 and 3 days, as well as problems getting your ERA and 277 files from the new contractor. Despite these reports, PSS is still advising ALL of their clients to contact Noridian ASAP and ask for early on boarding. PSS has been dealing with Noridian for over a decade, and in our experience, we don’t expect things to be better if you wait, we expect them to be worse. Those who opt for early on boarding are much more likely to get a representative to address any issues than those who wait. The question is, do you want to stand in a short line now, or a huge line later?
We will be releasing a video on how to make this transition within the next 2 weeks. If you are a Complete Care Priority Support client, PSS will handle the transition for you at no charge. You may also follow the instructions on the video to transition. The update is completely free, but if you are not a Complete Care Priority Support customer, and you request PSS assist with setting up the transition, our normal charges will apply for the transition.
For many years, Validator users have enjoyed the ability to send their commercial claims to Availity for no charge. Availity was getting enough revenue from payers they did not have to charge our clients for the right to send claims. Unfortunately, the wheels are starting to fall off the free claims train.
Pressured by a reduction in payments from insurance carriers, as well as vast reductions in how many carriers are willing to pay for claims, Availity has decided to ditch its free claims model in favor of a more traditional pay model, requiring all providers submitting claims to sign up for a monthly fee based solution through a reseller.
They are rolling out this plan in phases depending upon which state you are in. Texas submitters are already facing a hard cutoff date of August 17th. Providers in the following states are currently being transitioned, although the final cutoff date has yet to be announced.
Eventually all states will be affected by these changes. PSS has signed up as a reseller for Availity and we have negotiated special rates with other clearinghouses as an alternative option. To avoid a delay in claims processing, we highly encourage all of our clients, but especially those listed in one of the states above, to contact Lee Campbell at 877-527-2407 x112 to discuss your options.
This weekend (August 3-5), McKesson IT will perform the following server maintenance on key systems.
Maintenance Period: 10:00 PM (PDT), Saturday, August 3, 2013 - 4:00 AM (PDT), Sunday, August 4, 2013
May affect the following:
The following systems will not be affected by this maintenance period:
Don’t wait, call now and make sure you’re ready for ICD 10! Contact Lee Campbell 877-527-2407 x112 or firstname.lastname@example.org
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