ATTN: Medicare Electronic Funds Transfer (EFT) – JH Implementation Alert

Colorado Providers:nnWe are getting a new Medicare Administrative Contractor (MAC). No longer will Trailblazer be our Medicare contractor. The new company, Novitas Solutions, Inc.nnIf you receive payments through EFT (and you probably do) you must update your information.nnIf you need assistance please e-mail us at info@WHPelter.comnnDO NOT leave this to chance. Payment disruptions (you have heard the horror stories) can be avoided by being proactive.nn

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Medicare Electronic Funds Transfer (EFT) – JH Implementation Alertn IMMEDIATE ACTION REQUIRED TO AVOID PAYMENT DISRUPTION

nDear Provider:nnWelcome to Novitas Solutions, Inc., the Jurisdiction H (JH) Medicare Administrative Contractor (MAC). Our goal is to ensure a smooth transition of your services from your current contractor, TrailBlazer Health Enterprises (TrailBlazer), to Novitas Solutions as the JH MAC. As part of this transition, the Centers for Medicare & Medicaid Services (CMS) requires each active provider/supplier currently enrolled for EFT with TrailBlazer to continue receiving electronic payments from Novitas Solutions.nnTo ensure continued receipt of your electronic payments, the CMS requires you have a 05/10 version of the CMS-588 EFT Authorization Agreement (Agreement) on file with Novitas Solutions. Failure to have a 05/10 version of the Agreement on file with Novitas Solutions may result in a delay or interruption of your Medicare payments post-transition.nnPlease review the below information to determine the type of action you need to take in response to this letter:n

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• If you completed and submitted a 05/10 version of the Agreement to TrailBlazer prior to May 29, 2012 for Part B providers and May 30, 2012 for Part A providers, you are permitted to submit a copy of that Agreement to Novitas Solutions at the address provided on the second page of this letter.

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• If you have never completed the 05/10 version of the Agreement, or you did not maintain a copy of a previously submitted 05/10 version, you are required to submit a new 05/10 version of the Agreement to Novitas Solutions at the address provided on the second page of this letter.

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• The requested 05/10 version of the Agreement is for the continuation of existing EFT payments. Novitas Solutions cannot accept EFT changes (i.e., changes in bank routing information or authorized representative changes) prior to the planned implementation date of October 29, 2012 for Part A providers and November 19, 2012 for Part B providers. If you wish to change your existing information, please submit those changes to TrailBlazer in advance of the cutover.

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nChanges to EFT information submitted to TrailBlazer on or after May 29, 2012 for Part B providers and May 30, 2012 for Part A providers will be forwarded to Novitas Solutions as part of the transition, no further action is needed on your part.nnNOTE: You are not required to complete a CMS-855 Enrollment application as part of this process. For your convenience we have enclosed a hard copy 05/10 version of the Agreement for you to complete.nnThe “Instructions for Completing the EFT Authorization Agreement” on page 3 of the CMS-588 form provides specific instructions for completion of the agreement. The following are additional tips for completing the CMS-588 form:n

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• CMS-588 Part I – Check the New EFT Authorization box as the reason for the submission (already checked on the attached copy).

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• CMS-588 Part II – Ensure that you complete the Medicare Identification Number (your Medicare provider transaction access number (PTAN) or CMS certification number (CCN) that you currently use as issued by the outgoing contractor) as well as the National Provider Identifier (NPI).

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• CMS-588 Part III – Ensure banking information is provided including financial institution name, routing number,account number and type of account.

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• CMS-588 Part IV – Enter the name and telephone number of a contact person who can answer questions about theinformation submitted.

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• CMS-588 Part V – Ensure that your organization’s authorized or delegated official signs the CMS-588 form.

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nIn the event that you need another copy of this form, you may also download a blank agreement from the CMS Website at www.cms.hhs.gov. Please write “JH Transition” at the top of the form for easier identification.nnSubmit a copy or newly completed 05/10 version of the Agreement within 30 days from the date of this letter to the address below:n

Novitas Solutions, Inc.nProvider Enrollment ServicesnJH TransitionnPO Box 890095nCamp Hill, PA 17089-0095nAttention: Shelley Kuhn

nYou will receive a letter notifying you when your application has been processed. Should you have questions or need assistance, see our JH transition website at www.novitas-solutions.com or call us at 1-877-235-8073. Please be sure to identify yourself as a JH provider to expedite the handling of your call.nnThank you for your cooperation. We look forward to serving you.nnSincerely,nProvider Enrollment ServicesnNovitas Solutions, Inc.