JULY MARKS SWITCH TO NEW MEDICARE PART B CARRIER By Seth M. Wolf, Esq. (This article originally appeared in Crain's Cleveland Business on 03/04/02) Columbus-based Nationwide Mutual Insurance Co., which has been Ohio's Medicare Part B carrier since the start of the Medicare program in 1966, has withdrawn as the Part B carrier for Ohio and West Virginia. The new carrier will be Blue Cross and Blue Shield of South Carolina. Medicare Part B carriers generally are private companies that contract with the government to administer Medicare claims for the services of physicians, ambulatory surgical centers and other health care providers. Part B carriers are given authority by the government to administer Part B claims in a specific geographic area, typically one or more states. For purposes of its Medicare administration functions, Blue Cross and Blue Shield of South Carolina does business under the name Palmetto GBA. It has significant experience in the area and also is the Part B carrier for South Carolina. A representative on Palmetto GBA's special hotline for transition issues recently answered some commonly asked questions about the transition. Q: When will the transition occur? A: Palmetto GBA officially will become Ohio's Medicare Part B carrier July 1. Q: How will claims be handled after the transition, especially claims that were in process at the time of the transition? A: Palmetto GBA is working to hire the Nationwide employees who fulfilled Nationwide's Part B carrier function. Palmetto GBA also is planning, for the time being, to continue to use the same office locations in Ohio that Nationwide uses now. Therefore, the current plan (subject to change) is for Part B providers in Ohio to continue to submit claims in the same way, and to the same locations, as they did prior to the transition. This applies to both paper and electronic claims. Q: Over the years, Nationwide has issued numerous Local Medical Review Policies, which describe whether particular health care services are covered under different circumstances. If I don't follow the policies, I might not get paid, or worse, I might be accused of fraud. Palmetto GBA is the Part B carrier for South Carolina and also has issued its own set of policies, which might not be the same as Nationwide's policies. After the transition, will Ohio Part B providers have to follow the policies issued by Nationwide or by Palmetto GBA? A: For the time being, Palmetto GBA plans to utilize the policies published by Nationwide, and so Ohio Part B providers will not need to learn new coverage rules immediately. However, Palmetto GBA is planning to review carefully all Nationwide's existing policies, so the rules in the policies issued by Nationwide might change over time. Palmetto GBA has stated that it will give Ohio providers ample notice of any changes that are made, through bulletins, educational sessions, and other methods. Q: I have a contact person at Nationwide who I call to ask all my Part B questions. Will I still be able to call this person after the transition? A: Palmetto GBA is attempting to hire the Nationwide employees who handled the Part B carrier function on behalf of Nationwide. There is a good chance that your contact will continue on as an employee of Palmetto GBA, though this is not guaranteed. Q: I have submitted, or I am going to submit, one of the Medicare 855 forms to enroll a new physician in Medicare, or to make changes to my information in Medicare's files. Should I submit this form to the same address as before? What happens if the transition occurs between the time that I submit the form and when it is processed? A: For the time being, the plan is for the various 855 forms submitted by Part B providers to be sent to the same location used by Nationwide. Because Palmetto GBA is attempting to hire the Nationwide Part B staff, it does not anticipate that the transition will cause delays in the processing of these forms. Q: Where can I find information about the transition. A: Palmetto GBA has established a special Internet site devoted to the transition at pgba.com. Click ``providers,'' then click ``Part B Carrier - Ohio West Virginia Transition.'' In addition, Palmetto GBA has established a hotline at 803-763-3888. Palmetto GBA also will hold educational sessions throughout Ohio to discuss the transition.    | Practice Areas | Attorney Profiles | Publications | | Seminars | Screen for Exclusion | Contact Info | | Directions | Home | Rolf & Goffman Co., L.P.A. Phone 216-514-1100 E-mail info@rolfgoffman.com