The Texas Medicare Administrator Contractor changes from TrailBlazer to Novitas (formerly Highmark Medicare Services)

For many years, TrailBlazer Health Enterprises, LLC  (TrailBlazer) was both the fiscal intermediary (Part A) and carrier (Part B) for providers located in Texas.  TrailBlazer was responsible for the fee-for-service Medicare payments, local coverage decisions and physician enrollment into the Medicare program. However, beginning the summer of 2012, some things will change.

In November 2011, the Centers for Medicare and Medicaid Services (CMS) announced that Highmark Medicare Services will become the Medicare Administrator Contractor (MAC) for a large region of the country that includes Texas.   The contract is for one year, with the option of four annual renewals.  Effective January 1, 2012, Diversified Service Options, Inc, a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida Inc, acquired Highmark Medicare Services from its parent company, Highmark Inc. As a result, Highmark Medicare Services changed its name to Novitas Solutions, Inc. Novitas is currently the A/B MAC for Delaware, New Jersey, Pennsylvania, Maryland, the District of Columbia, and the Part B MAC for certain areas within Virginia.

Effective July 2012, Texas will be part of Jurisdiction H, along with Arkansas, Colorado, Louisiana, Mississippi, New Mexico, and Oklahoma.  CMS consolidated two former MAC jurisdictions – Jurisdiction 4 comprised of Colorado, New Mexico, Oklahoma, and Texas, and Jurisdiction 7 comprised of Arkansas, Louisiana, and Mississippi.  Novitas will also process Indian Health Service facility claims for the entire country and serve as the designated A/B MAC to support centralized billing for Mass Immunizers. CMS estimates that about 4.9 million Medicare beneficiaries reside in Jurisdiction H with approximately 1,300 Medicare hospitals, and over 147,000 physicians and other practitioners that furnish health care services to Medicare beneficiaries in this jurisdiction.   CMS approximated that Jurisdiction H will account for approximately 13.2% of all Medicare fee-for-service claims nationally.

Novitas recently announced the anticipated cut-over dates for the transitions, which will start in mid-August and go through November 2012 (with Part B for Colorado, New Mexico, Oklahoma, and Texas being the last to switch over).  Since Novitas has prior experience as a MAC for a number of eastern states, CMS anticipates that the transfer to a new MAC will go smoothly, with few disruptions for Medicare beneficiaries or providers.   However, providers should prepare for possible delays and implementation glitches.  Providers also should be mindful of any notices sent from Novitas as well as TrailBlazer regarding updated dates and procedures under Novitas.