We are in the final stretch of the great DME MAC transition of 2016. On July 1st the MACs will be shifting from four contractors (NHIC, National Government Services, CGS, and Noridian) to just two contractors (CGS and Noridian). The jurisdictions themselves will remain intact and will continue as jurisdictions A, B, C and D; but they will be administered by two contractors instead of four.
As with any transition (especially one of this magnitude), there are lots of supplier questions:
As with any transition (especially one of this magnitude), there are lots of supplier questions:
- Should we expect changes with how our claims are processed?
- Will the same issues be audited under the new contractors?
- Will my payments be delayed or interrupted?
- Where will I send my claims?
While we do anticipate a smooth transition for both Jurisdictions, suppliers must be attuned to changes they must make internally to stay in concert with the MAC migration. At critical junctures, suppliers will be responsible for updating their billing software and processing guidelines to avoid claim processing issues and revenue bottlenecks.
Suppliers can mitigate this risk by following these simple steps:
The best way to ensure your operations continue without issue is to be proactive and resist the urge to keep the auto-pilot engaged during this transition.
Suppliers can mitigate this risk by following these simple steps:
- Sign up for the list serves.
- Monitor the implementation webpages for any posted changes.
- Follow instructions provided by the MAC to update billing systems in a timely fashion.
- Proactively scan incoming documentation to ensure related responses (ADRs, redeterminations) are routed to the proper address.
- Communicate with your staff to be on the lookout for any unusual occurrences over the months of June and July.
The best way to ensure your operations continue without issue is to be proactive and resist the urge to keep the auto-pilot engaged during this transition.