DME
MAC Jurisdiction C Frequently Asked Questions (FAQs)
General FAQs Archive
Question: When can I expect to receive a decision on my Redetermination?
Answer: The Redetermination requests are being worked on a first in, first out basis as quickly as possible. We apologize for the delays and appreciate your patience as we implement plans to reduce the workload to alleviate the extended processing time. If the request was submitted on or after June 1, 2007 , an acknowledgement letter is sent to confirm receipt of the request. Once it is determined that a redetermination request is on file, it is not necessary to perform any additional submissions.
Question: Can CSRs make claim adjustments over the phone?
Answer: CSR's are not allowed to complete telephone adjustments. If a simple adjustment is required due to a minor error or omission (e.g., change of date of service, addition of modifier, change of place of service, etc.) a reopening request may be submitted via fax, mail, or telephone. Please review the following link for additional information about Reopenings: http://www.cignagovernmentservices.com/jc/pubs/news/2007/0807/cope6275.html
Question: Can I speak to an Ombudsman?
Answer: With the implementation of Jurisdiction C DME MAC, the Ombudsman process has been changed. The Customer Service Department is available to answer any complex claim or coverage questions. If the first tier CSR is unable to answer a question, Tier 2 or PRRS (Provider Relations Research Specialist) will assist and resolve the inquiry. The Provider Outreach and Education (POE) team responsibilities include identifying and creating self-service training materials for the of Medicare suppliers. Please review the Education site at www.cignagovernmentservices.com/jc for more details.
Question: The other Jurisdictions do not require beneficiary consent to release same or similar / previous CMN information. Why do you?
Answer: In order to assist in protecting the privacy of the Medicare beneficiaries and suppliers, CIGNA Government Services made the decision to require beneficiary consent on pre-claim inquiries.
Question: I'm a new supplier. The NSC said I need to get a waiver from you to file paper claims. Can you send me this waiver?
Answer: The Administrative Simplification Compliance Act (ASCA) has certain exceptions for paper claims. An electronic claim waiver is not required until CIGNA Government Services contacts the supplier requesting one. We will send the forms out upon determining that a supplier does not meet the waiver requirements.
Question: What is a PTAN?
Answer: The PTAN is the Provider Transaction Access Number. This number is the DME Provider Identification Number (supplier number) assigned by the NSC (National Supplier Clearinghouse). This number is used to for identification when contacting the customer service contact center and the IVR (Interactive Voice Response) system.
Question: Do we have to have an original "pen and ink" signature on prescriptions and CMNs?
Answer: Written orders may take the form of a photocopy, facsimile image, electronically maintained, or original "pen and ink" document. (Reference: CMS Manual System, Pub. 100-8, Medicare Program Integrity Manual, Chapter 3, section 3.4.1.1.B.)
Question: What is the anticipated cutover date?
Answer: June 1, 2007
Question: Why is the contract changing from Palmetto GBA to CIGNA Government Services?
Answer: In 2003, Congress enacted legislation known as the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. Under section 911 of the MMA, Congress required CMS to replace the current fiscal intermediary (FI) and carrier contracts with competitively procured contracts that conform to the Federal Acquisition Regulation (FAR). The legislation required the government to competitively bid all Medicare contracts. The first awards of the full and open MAC competitions were for the Durable Medical Equipment (DME) claims workloads. CMS decided to start the Medicare Contracting Reform initiative with the DME MAC contracts because the workload of the four DMERCs was stable and the risk of any significant program disruption to the provider and beneficiary communities would be minimal.
Question: What states will be involved in the implementation of Jurisdiction C?
Answer: All states currently part of the Region C DMERC will transition. In addition, Virginia and West Virginia will also become part of Jurisdiction C. The Jurisdiction C states and insular areas are: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia.
Question: Why are you using the term DME MAC instead of DMERC, and Jurisdiction C instead of Region C?
Answer: Under the Medicare Modernization Act (MMA) of 2003, CMS reviewed the geographic location of all DMERCs and created Durable Medical Equipment Medicare Administrative Contract (DME MAC) jurisdictions. This terminology replaces the DMERC "Regions" previously used to describe the contracts. In some instances, "regions" were realigned to balance the workload across the new jurisdictions.
Question: How is National Government Services, Inc. (formerly AdminaStar Federal) involved in the implementation of Jurisdiction C?
Answer: National Government Services, Inc. (formerly AdminaStar Federal) currently serves the states of Virginia and West Virginia, which will be transitioned to Jurisdiction C. CIGNA Government Services will partner with them, as well as Palmetto GBA, during the implementation.
Question: Where can I learn more about the DME MAC implementation for Jurisdiction C and what it means to me?
Answer: Important implementation information is available now on the CIGNA Government Services Web site at: http://www.cignagovernmentservices.com/transition . We encourage you to also sign up for our ListServ, which will automatically provide you with announcements and information.
Question: How can I sign up for the CIGNA Government Services ListServ?
Answer: A link is provided from our CIGNA Government Services Web site, http://www.cignagovernmentservices.com/transition. Sign up now to start receiving announcements.
Question: Where is CIGNA Government Services located?
Answer: The CIGNA Government Services office for the DME MAC contract is located in Nashville, TN. This will result in changes to where you send inquiries, claims, and other items. The new address is P.O. Box 20010, Nashville, TN 37202. Watch for future announcements regarding when to start sending claims and inquiries to CIGNA Government Services.
Question: Does CIGNA Government Services have any experience with this type of work?
Answer: Yes. CIGNA Government Services was the DMERC contractor for Region D from its inception in 1993 until October 2006. Many of the same experienced staff will now be part of the DME MAC for Jurisdiction C.
Question: When do we start sending claims and inquiries to CIGNA Government Services?
Answer: The final start date for CIGNA Government Services will be June 1, 2007. Watch ListServ announcements and our implementation Web site for updates and details.
Question: Will TrustSolutions, LLC still be the Program Safeguard Contractor for us?
Answer: Yes. There will be no change with the Program Safeguard Contractor for Jurisdiction C. TrustSolutions, LLC will continue to perform medical review and benefit integrity work. They will also continue to process your requests for Advance Determination of Medicare Coverage (ADMC). Virginia and West Virginia providers will transition to TrustSolutions, LLC.
Question: What if I have pending claims or inquiries at Palmetto GBA at the time of the cutover to CIGNA Government Services?
Answer: CIGNA Government Services will be partnering with Palmetto GBA and National Government Services, Inc. (formerly AdminaStar) on the transfer of any pending work at the time of the cutover. CIGNA Government Services will honor the date of receipt recorded by these contractors and will adhere to the same timeliness goals.
Question: I currently receive my Medicare payments electronically from Palmetto GBA. How can I continue to receive them electronically from CIGNA Government Services?
Answer: As a Medicare provider/supplier in Jurisdiction
C, you are required to complete the EFT Enrollment form to continue
receiving electronic transfer of payments from CIGNA Government Services.
The form is located on the transition section of our Web site at: http://www.cignagovernmentservices.com/transition or
at http://www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf 
.
It is important to complete and return the EFT form as quickly as
possible to ensure your payments continue once implementation is
complete. You may also refer to the separate EFT article in this
newsletter for more information.
Question: Will Jurisdiction C just be for DME?
Answer: Yes, Jurisdiction C will have the same scope as the previous Region C DMERC in regard to the types of claims it processes. Generally, claims for DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies) are included.
Question: Where can I get help in how to fill out an EFT form?
Answer: We now have an online tutorial on our transition website to aid suppliers in filling out their EFT applications. Please visit http://www.cignagovernmentservices.com/transition and click on the Online Education link at the top of the page. You'll find an online tutorial that will walk you through each line of the application.
Question: Will CIGNA send out a confirmation to let me know my EFT form was received?
Answer: Because of the volume of EFT applications we have to process, you will not be receiving confirmation that we have received your application. However, CIGNA Government Services will be sending out follow up letters to any supplier who has not submitted an application by April 13, 2007. If you do not receive one of these letters in the next two weeks or a letter indicating additional followup on your application, you can assume your application was received.
Question: Where is the CMS-855 application located?
Answer: The CMS-855S (for DME suppliers) may be accessed
at www.cms.hhs.gov/cmsforms.
The National Supplier Clearinghouse also offers “Helpful Hints” for
completing the CMS-855 form at the following link: http://www.palmettogba.com/palmetto/providers.nsf/44197232fa85168985257196006939dd/
85256d580043e75485256b26005cc73b?OpenDocument
Question: How do we obtain same or similar equipment on file for a beneficiary?
Answer: To obtain same or similar equipment on file, contact the Jurisdiction C DME MAC customer service department at 866.270.4909 with the beneficiary on the line. The beneficiary must provide verbal authorization before equipment on file may be released on a pre-claim basis. If your claim has already denied for same or similar, the equipment on file may be released without consent from the beneficiary once supplier disclosure validation has been completed.
Question: Why didn’t I receive my remit notice?
Answer: If you are enrolled for electronic remittance advices, CMS does not allow the mailing of paper Medicare Remittance Notices. This rule also applies to suppliers who receive paper checks; so it is possible to have an electronic remittance notice with a paper check.
To review the electronic remittance advice it is necessary to upload the remit. Please view the Jurisdiction C EDI website for information on accessing the Medicare Remit Easy Print (MREP) at: http://www.palmettogba.com/palmetto/jcedi.nsf/docsCat/Medicare%20Remit%20Easy%20Print%20(MREP)%20Software%20Download%20for%20JCEDI?Open&cat=JCEDI~Software%20&%20Manuals.
You may also access additional MREP information from the CMS website at: http://www.cms.hhs.gov/AccesstoDataApplication/01_Overview.asp#TopOfPage
If you no longer want to receive electronic remittance advices, you may disenroll and request Standard Paper Remittance Notices through JCEDI at: http://www.palmettogba.com/palmetto/jcedi.nsf/docsCat/JCEDI%20Suppliers%20Requesting%20Standard%20Paper%20Remittances%20(SPRs)?Open&cat=JCEDI~EDI%20Enrollment
