Medi-Cal Rx Email Domains, Mailboxes, and Meeting Links Transitioning to Prime Therapeutics

As a result of Prime Therapeutics’ acquisition of Magellan Rx, a series of application transitions have been scheduled for the first half of 2024, as previously announced in the alert titled Upcoming Transitions for Medi-Cal Rx Applications. Transitions include changes to some email address domains, including the Medi-Cal Rx Education & Outreach (E&O) mailbox. 

Click here for the complete notice.

Medi-Cal Rx Prior Authorization Submission Outage on March 22, 2024

As a result of Prime Therapeutics’ acquisition of Magellan Rx, a series of transitions for Medi-Cal Rx users is scheduled for the first half of 2024, as previously announced in the alert titled Upcoming Transitions for Medi-Cal Rx Applications. As part of this migration, there will be a planned outage on Friday, March 22, 2024, during which prior authorization (PA) request submission will be unavailable.

Click here for the complete notice.

The following news is from the JD Q1 Association Communication from Noridian:

CMS Awards Noridian Medicare DME Contract for Third Time

Noridian proudly announces the re-award of the Durable Medical Equipment Medicare Jurisdiction D contract. The Centers for Medicare & Medicaid Services (CMS) recently re-awarded Noridian the $152.8 million contract, concluding a full-and-open competitive procurement. Covering 17 states and three U.S. Territories, Noridian processes more than 13 million Fee-For-Service (FFS) claims for nearly 25,000 DME suppliers and 8.7 million beneficiaries, resulting in $2.6 billion in payments. The contract start date is September 1, 2024. The contract period for the new award includes a base year and the option for six one-year option periods.

As the incumbent, Noridian is technically already 100 percent implemented and ready to go. The transition means no disruption to beneficiaries, suppliers, or Medicare operations. We will communicate any CMS expectations for the implementation period that impact you, as our business partner, as we finalize these details with CMS.

Please reach out with any questions. We look forward to continuing to work with you as we service suppliers and beneficiaries in JD.

Items Provided on a Recurring Basis and Request for Refill Requirements- Annual Reminder

The Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) Joint Publication article, Items Provided on a Recurring Basis and Request for Refill Requirements – Annual Reminder – January 2024, has been created and published to our website. Read the completed update.

Home Assessment for Manual Wheelchair - Reminder

The Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) Joint Publication article, Home Assessment for Manual Wheelchairs - Reminder, has been created and published to our website. Read the complete update.

Requesting Claim Examples

Noridian seeks the assistance of suppliers in providing examples of claim scenarios and billing documentation for which they have received payment or denials. Read the complete update.

DMEPOS Competitive Bidding Program: Temporary Gap Period

Effective January 1, 2024, and thereafter, a temporary gap period will be in place for the Competitive Bidding Program (CBP) for off-the-shelf back and knee braces. The competitive bid modifiers KV, J4, and J5 are longer applicable. For HCPCS codes L0648, L0650, L1833, and L1851, treating practitioners now have the flexibility to choose between following the standard prior authorization process with its typical timeframe for review, requesting an expedited review, or utilizing the ST modifier to indicate an acute/emergent need. It is important to note that this process change specifically impacts Non-Contract Competitive Bid Suppliers who are practitioners/physicians, physical therapists, and occupational therapists. For further details, please consult the Timeline and Updates section of the Prior Authorization and Pre-Claim Review Initiatives webpage on the CMS website.

Lymphedema Compression Treatment Items Requirement for Registration with the Food and Drug Administration

Suppliers are reminded that before billing the Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) for a medical device, the device, at a minimum must be registered with the Food and Drug Administration (FDA). This requirement includes Lymphedema Compression Treatment Items. Devices that are not registered as a medical device must be billed with A9270 (Noncovered item or service). Refer to the CMS Internet Only Manual Publication 100-2 Chapter 14 Section 10 and 21 CFR 880.578. 

3-D Printed Orthotic Devices – Correct Coding

The Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) Joint Publication article, 3-D Printed Orthotic Devices – Correct Coding has been created and published to our website. Read the completed update.

CGM Disparity Webinar

Clinicians join us on March 26, 2004, at 2:00 PM Central for the Continuous Glucose Monitors (CGM) webinar titled Manage Diabetes with Confidence Using Continuous Glucose Monitors.

Suppliers invite your clinicians to attend the CGM webinar titled Manage Diabetes with Confidence Using Continuous Glucose Monitor being held on March 26, 2024, at 2:00 PM Central Time. This webinar is in collaboration with Medicare Part B Jurisdiction E and will address how the medical community can expand Medicare beneficiaries' access to CGM devices by removing obstacles to CGM use through appropriate education. This webinar will cover the following topics:

• What is a CGM?
• Why are we discussing CGMs?
• Who are your patients?
• Benefits of CGM
• Medicare requirements for Continuous Glucose Monitor (CGM) Coverage
• CGM Supply Allowance
• Documentation Requirements
• Overcoming Roadblocks for Beneficiaries
• Fear of Change
• New Technology
• Cost

The link to register for this webinar is located on the Noridian JE website or click here to register.

Medicare Beneficiary Identifier (MBI) Replacement for Lost or Stolen Cards

In the event of a lost or stolen Medicare card, beneficiaries will be issued a new Medicare Beneficiary Identifier (MBI) number. Suppliers must promptly transition to billing with the newly assigned MBI when a beneficiary receives a replacement. Read the completed update.

DME MACs at Medtrade in Dallas

Coming to Dallas for Medtrade in late March? The DME MACs will be there. Read the complete update.