Palmetto GBA will process Medicare claims in California beginning in the summer of 2008.

Everything here applies to clients in California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands irregardless of where you got your Stratford program.

This DOES NOT APPLY TO NHIC clients in the Northwest. This does not apply to Noridian clients in other states. This does not apply to NGS clients in other states. They will continue to use the Stratford program to bill Medicare with no changes at all (in fact, those clients should not even read this web page).

Q: Will I be able to use Stratford to bill Palmetto GBA? I got the Stratford program from NHIC in California. I do not want to reenter any of my patient data. I want to be able to send patient statements, bill private payers, and all the other things I have been doing.

A: Yes. Your database will work as usual without any changes to your patient data. You will continue to get support from us. We have worked with Palmetto GBA to facilitate connectivity to their Gateway. Transition instructions for doing so via HyperTerminal were prepared jointly, and will be posted on the Palmetto GBA website, www.PalmettoGBA.com as well as our web site. During the transition from NHIC to Palmetto GBA, Palmetto GBA or Stratford will assist you in connecting to Palmetto GBA. There will soon be a new, more streamlined Hyperterminal connectivity script available for your software. Notification of this script will be posted on both websites for your convenience. We would be happy to supply software to Palmetto GBA like we now do to EDS/NHIC and other payers. This may happen in the future. At this time you will need to obtain support directly from Stratford. When you get support directly from Stratford, you will be upgraded to the latest program with patient statements, scheduling, electronic medical records, electronic prescriptions and all the other features which are standard with Stratford Software.  You will also be prepared for the coming change to the ANSI X.12 v5010 EDI format. You will have EDI to all payers and clearinghouses that accept EDI (there may be some exceptions depending on whether the payer will accept HIPAA compliant claims and some other factors) as well as all other Stratford functions - there are NO add on 'modules' - all functions are included.

If anyone tells you anything other than this, we would appreciate hearing from you so we can research it and make sure that no one is spreading false rumors - possibly to require you to change to a different program.

Q: Will Stratford support help me transition from NHIC to Palmetto GBA?

A: Yes. You may begin the transition from NHIC to Palmetto GBA immediately.

Note that Palmetto GBA will not begin processing claims until 09/02/2008. However, you may begin sending claims to Palmetto GBA beginning NOW. Palmetto GBA will send your claims to NHIC for processing until 09/02/2008. We suggest that you convert NOW and not wait until the last minute. That way you will not be in line with thousands of other people who waited. There is no reason to wait until you are forced to change and/or your claims are rejected. If you begin NOW, Stratford support will have time to help you get through any glitches so that by September 2, you will be transmitting smoothly and you will not even realize that Palmetto GBA is your new Medicare contractor.

Procedure:

1. You must first fill out the Jurisdiction 1 EDI Application Form here: www.PalmettoGBA.com/J1 under the Electronic Data Interchange (EDI) Link. You must return the EDI Agreement to Palmetto GBA no later than 08/29/2008 or your EDI will be interrupted for an unknown amount of time and you could have a problem with cash flow. Please do not delay completing these forms. We suggest you do it NOW.  If you have trouble getting these forms, please contact Stratford support. We will help you.

2. After you receive a response from Palmetto GBA, you can enter this information into the insurance control screen in the Stratford program. Stratford support can help you - just email or call or fax. Remember, if you wait until the last minute, there could be a delay depending on how many other people wait until the last minute. We hope you will contact us immediately after you receive the ID and password from Palmetto GBA so we can schedule time at your convenience and the transition will be as smooth as possible.

3. You must not change the payer ID in your software to the new Palmetto GBA ID until Palmetto GBA tells you to do so. For example, if you are now transmitting to NHIC/Southern California with the payer ID 31146, you will not change that number, even though you have begun 'early boarding' and you are transmitting to Palmetto GBA. You will be contacted by Palmetto GBA when they want you to change your payer ID to 01192. If this is not clear and/or you have trouble and/or you just want someone to help you, please contact Stratford support. We are here for you and we want to help. We understand that this change is simple for some people and for other people it is a headache and they wish they did not have to deal with it. It is something you must do. We will do our best to help you. Do it now and get it over with, that is our suggestion.

Click here: Instructions for setting up the Windows Hyperterminal program to transmit to Palmetto GBA

Notes:

• The dates and procedures above are specific for NHIC/California Part B clients.

• Noridian Part B: Hawaii, Nevada  - claims will begin processing 08/04/2008. Early boarding begins May 10, 2008

• NGS Part A: California, Hawaii, Nevada - claims will begin processing 08/18/2008. Early boarding begins May 1, 2008.

• If you get electronic remittances now, you will continue to get them. If you now auto-post in your Stratford program, you will continue to be able to auto-post.

• Palmetto GBA will return the TA1/997 and 276 when you transmit a 276 claim status request.

• If you receive payment by EFT, you must fill out a new agreement form CMS-588 with Palmetto GBA as it cannot be transferred from your present contractor.

Here are some details that most people will not be interested in, but if you are...

The new payer ID goes in these segments in the ANSI X.12 v4010/5010 A1 EDI transaction set:

As always, you are welcome to email or fax any comments you have to us at (650) 344-1073
 

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Last modified: 05/27/08