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                                                                                              Type of Meeting: J4 – Oklahoma/New Mexico Talk to TrailBlazer
                                                                                              (TTT) Teleconference

Meeting Date: December 10, 2007       TrailBlazer Attendees: Deb Clayton, Angie               Absentees: N/A
Minutes Taken By: Leigh Ramsey        Cooper, Becky Farris, Charles Haley, Pat
                                      Laymon, Cheryl Leslie, Pat Lewis, Janet
                                      McKinney, Carol Michael, Steven Mildward, Debra
                                      Patterson, Carol Payne, Leigh Ramsey, LJ Smith,
                                      Gary Warczak, Paula Zappala

                                      Companies Represented: CMS

                                                                                                                    Responsible Person/
      Agenda Items                            Discussion/Minutes                              Action Required                                    Due Date

Roll Call                Steven Mildward, J4 TTT Project Administrator. Mr. Mildward
                         welcomed all to the call and took roll.

Welcome/TrailBlazer      Pat Laymon, J4 Segment 3 Manager. Ms. Laymon welcomed
Introductions            all attendees and explained that conference calls will be one of
                         the main communication tools throughout the implementation
                         process. Talk to TrailBlazer Teleconference (TTT) calls will take
                         place every other Monday, beginning again on January 7, 2008.
                         Agenda items will be solicited prior to the calls.
J4 A/B Implementation    Pat Lewis, J4 Customer Service Manager. Ms. Lewis gave a
Update                   brief summary of the new Medicare Administrative Contractor
                         (MAC) environment. Under Title 18 there were 33 A/B
                         contractors. In the MAC environment there will be 15 A/B
                         jurisdictions, each with a five-year competitive bidding contract.

                         Oklahoma/New Mexico tentative segment cutover date is March
                         1, 2008.

                         TTTs will be held for each segment implementation to ensure

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Create date: 9/10/2007
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      Agenda Items                           Discussion/Minutes                             Action Required                         Due Date

                         lines of communication are open early and often for both the
                         contractor and provider communities.

                         Key goals for implementation are:

                         •   Minimal disruptions to beneficiaries, providers, physicians
                             and suppliers.
                         •   No disruption of claims processing and Medicare
                         •   Transition is completed on schedule.
                         •   All parties with a vested interest in the MAC changeover are
                             kept informed of implementation status and progress.

                         Because of the tight MAC transition time frames and that no
                         new system retraining will be needed, we will not conduct
                         seminars or workshops during the implementation phase.
                         Providers will need to be aware that our primary means of
                         communication and sharing information will be via listserv and
                         teleconferences during this time. This strategy will allow more
                         staff to focus on the primary MAC transition goal for a seamless
                         claims processing and payment changeover. TrailBlazer will
                         begin normal face-to-face outreach as soon as we can to meet
                         our new providers.

                         Local Coverage Determinations (LCDs) will be posted to the
                         Web site by December 15, 2007.

                         As soon as it is appropriate, we will share access to a Partner
                         and Provider Problem-Sharing Guide with contact information
                         for all levels of management, if needed to resolve issues that
                         cannot be resolved via normal channels.

                         Carol Payne, J4 Communications Workgroup Leader. Ms.
                         Payne reviewed several important changes that require action:

                             • Electronic Funds Transfer (EFT) – Those who currently
                               receive Medicare payments electronically and do not
                               already have claims processed by TrailBlazer need to

Created by: ROB
Create date: 9/10/2007
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      Agenda Items                            Discussion/Minutes                                  Action Required                         Due Date

                                prepare and submit an EFT agreement to TrailBlazer to
                                continue receiving EFTs after cutover. If you do not
                                submit an EFT agreement to TrailBlazer, you will continue
                                to get paid, but it will be via paper check.
                            • Electronic Media Claim (EMC) – The telephone number
                                you or your electronic submitter use to transmit electronic
                                claims to Medicare will change, Electronic Data
                                Interchange (EDI) reports will likely change somewhat,
                                and the telephone number you or your staff use for EDI
                                technical support will change.
                            • LCDs – All 800+ combined LCDs have been reviewed by
                                the J4 Medical Director, consolidated and approved by
                                CMS. The final 139 LCDs are targeted to be added to the
                                TrailBlazer J4 MAC site by December 15, 2007.
                                Comments regarding new consolidated LCDs may be
                                submitted to the J4 MAC inquiry e-mail address at
J4 Operational Highlights   1. Pat Laymon, Part B Provider Outreach and Education
1. Communication/              Manager. Ms. Laymon spoke in depth regarding
    Education                  communication efforts being made during the
2. Claims Processing           implementation period. As stated earlier, TrailBlazer will
3. Customer Service            rely predominantly on electronic mailing lists (listservs).
4. Electronic Funds            Both jurisdiction and segment-specific listserv mailing lists
    Transfer                   are being maintained. These listservs will accommodate
5. Electronic Billing          all providers served and be used to notify registrants of
6. Medical Director/Local      important, time-sensitive Medicare and implementation-
    Coverage                   related information, FAQs and available educational
    Determinations             materials and outreach activities. It is critical that providers
                               join these listservs to receive the information they need to
                               bill correctly and timely in the MAC environment. To
                               register for these listservs, access the TrailBlazer J4 MAC
                               Implementation Web site.

                              The J4 MAC Implementation Web site is another key tool.
                              This site will be used to provide status updates, segment
                              plans, schedules and activities, LCDs, key contact
                              information to help resolve issues and concerns, EDI,
                              enrollment and other J4 news throughout the jurisdiction

Created by: ROB
Create date: 9/10/2007
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                           Because the J4 multiple state segment implementation
                           time frames are tight and no major system changes are
                           involved that require retraining, TrailBlazer proposed an
                           implementation plan that will focus on the primary J4
                           implementation goal of ensuring this is as seamless as
                           possible and provides no disruption of service to
                           beneficiaries and providers.

                         2. Becky Farris, Part B Claims Manager. In Fiscal Year
                            (FY) 2007, TrailBlazer Part B claims processing workload
                            exceeded 110 million claims and will increase to
                            approximately 124 million when adding the Oklahoma and
                            New Mexico workload. TrailBlazer has an experienced
                            staff that has been through several workload
                            implementations and will help provide a seamless
                            transition. They are currently working closely with Pinnacle
                            to ensure that after implementation claims will continue to
                            process timely and accurately. The claims division also
                            works closely the Provider Outreach and Education (POE)
                            department and shares issues discovered during the
                            claims adjudication process so they can quickly pass
                            helpful information on to the providers. TrailBlazer’s
                            primary method of processing claims is via electronic
                            submissions, but also supports paper claims through
                            scanning and some manual entry claims.

                         3. Gary Warczak, Part B Customer Service Manager. The
                            Part B Customer Service department is responsible for
                            handling telephone and written inquiries and the
                            Interactive Voice Response (IVR) system. Last year our
                            call center handled 777,929 provider calls, and the IVR
                            received over 3 million calls. Currently, the department is
                            responding to over 300,000 IVR inquiries and 60,000
                            written inquiries per month. To aid in the increased
                            workload that will occur with the addition of Oklahoma and
                            New Mexico, the department is training new Customer

Created by: ROB
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      Agenda Items                        Discussion/Minutes                              Action Required                         Due Date

                           Service Representatives (CSRs) and adding IVR capacity.
                           The department is also working closely with Pinnacle to
                           identify policy and procedure differences and similarities
                           so they will be prepared for the March 1 cutover date.

                         4. LJ Smith, Part B POE Provider Relations Specialist.
                            Electronic Funds Transfer (EFT) is the methodology by
                            which Medicare payments are transferred electronically
                            from the MAC’s bank directly to the bank account of the
                            provider or the supplier. If we do not receive a new EFT
                            agreement from the outgoing contractor providers prior to
                            the cutover date, they will have to drop to paper until we
                            can collect and establish EFT agreements from them.
                            Instructions on how to complete the agreement will also
                            be shared via listservs, the J4 Web site and provider
                            letters. We began mailing letters last week that explained
                            EFT requirements and instructions for submitting the new
                            agreements. Providers currently serviced by TrailBlazer
                            will not need to submit a new EFT agreement. Providers
                            are encouraged to act early on completing the EFT
                            requirements and not wait until February 15, 2008, as
                            stated in the letter. We are ready to receive the new
                            agreements and process them as soon as received.

                         5. Paula Zappala, EDI Manager. Arrangements for
                            Medicare Electronic Media Claims (EMC) submission are
                            specified in the standard CMS EDI Enrollment Form. A
                            provider who wishes to establish EDI capability with any
                            contractor must complete the standard CMS EDI
                            enrollment form and submit it before production claims
                            can be accepted from that provider. Current EDI providers
                            who have completed an EDI enrollment form with the
                            outgoing contractor will not need to re-enroll and complete
                            a new form. Existing EDI enrollment forms will be
                            transferred to TrailBlazer at cutover.

                           Providers must have the ability to submit claims
                           electronically without disruption. TrailBlazer has

Created by: ROB
Create date: 9/10/2007
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      Agenda Items                      Discussion/Minutes                               Action Required                         Due Date

                         established a process known as “early boarding.” This
                         process will allow electronic submitters to send claims to
                         TrailBlazer prior to cutover and TrailBlazer will forward the
                         accepted claims to HCSC for processing.

                         The TrailBlazer front-end system, known as Gateway
                         Production Network (GPNet), is available 24 hours a day,
                         seven days a week. GPNet has an extensive editing
                         system and detailed response report that is returned
                         normally within minutes of transmission. For example,
                         when a HIPAA-compliant file is submitted to GPNet,
                         TrailBlazer will translate the file and return a 997 to the
                         submitter. Once the file is translated, the claim file is
                         forwarded to our front-end editing system. TrailBlazer will
                         return a response report to the submitter indicating any
                         claims that failed a front-end edit. This response report is
                         normally returned within minutes of transmission.

                         TrailBlazer will ensure that all providers and submitters
                         understand the changes that will take place due to the
                         MAC implementation. Providers will be given multiple
                         opportunities to receive the necessary training and test
                         prior to cutover. TrailBlazer will also provide technical
                         support for any problems associated with claims
                         submission and EDI.

                         TrailBlazer has secured a list of Submitter IDs currently
                         used by Pinnacle. The Submitter IDs will be compared to
                         existing Submitter IDs on GPNet. If the submitter is not on
                         GPNet, TrailBlazer will establish this ID on GPNet. If the
                         Submitter ID is currently being utilized by an existing
                         GPNet submitter, TrailBlazer will issue a new Submitter ID
                         on GPNet. We will be distributing notification to each
                         submitter of the GPNet Submitter ID and password by the
                         end of December. We encourage submitters to begin
                         migrating to GPNet as soon as possible, once notification
                         has been made, to avoid any delay.

Created by: ROB
Create date: 9/10/2007
                                                                                                             Responsible Person/
      Agenda Items                        Discussion/Minutes                               Action Required                         Due Date

                           Complete details and specifications about GPNet can be
                           found in the GPNet Communications Manual and the
                           GPNet Edits Manual on the EDI Web page at:

                           Current submitters to TrailBlazer will have no change to
                           their EDI process until cutover to the J4 MAC.

                           TrailBlazer has secured a list of Submitter IDs currently
                           being used to submit Oklahoma and New Mexico claims
                           to Pinnacle. If the Submitter ID is being used by a current
                           GPNet submitter, TrailBlazer will issue a new Submitter ID
                           and password. If the Submitter ID is not being used,
                           TrailBlazer will set up that existing Submitter ID on its
                           front-end GPNet with a new password. TrailBlazer will
                           provide notification to each submitter of their Submitter ID
                           and password. For those who utilize the free software
                           MCE, TrailBlazer will support the software during
                           implementation. However, after implementation, providers
                           will need to migrate to TrailBlazer’s free Pro32 software.

                         6. Charles Haley, MD, Contractor Medical Director.
                            TrailBlazer began analyzing all LCDs in Jurisdiction 4 very
                            early in the implementation to determine their applicability
                            jurisdiction-wide. In consolidating the LCDs, TrailBlazer is
                            required to select the least restrictive LCD from the
                            existing LCDs on a single topic and consolidate the active
                            edits in the system.

                           TrailBlazer analyzed the more than 800 existing LCDs and
                           determined that 139 will exist. TrailBlazer expects to
                           publish the 139 consolidated LCDs on the J4 MAC
                           Implementation Web site on Saturday, December 15,
                           2007. The policies may be found on the J4 MAC Web site
                           on the Draft LCDs page under Local Coverage
                           Determinations. The policies will have an effective date of
                           March 1, 2008, for Oklahoma and New Mexico and be
                           date of service-driven. No retroactive processing will occur

Created by: ROB
Create date: 9/10/2007
                                                                                                                Responsible Person/
      Agenda Items                            Discussion/Minutes                              Action Required                         Due Date

                               due to the LCD consolidation. TrailBlazer will notify
                               providers of postings via the J4 MAC Implementation
                               News listserv. Should physicians, practitioners, facilities,
                               suppliers and other providers have questions or
                               comments on the new consolidated LCDs, they may
                               submit those to the J4 MAC inquiry e-mail box at
Frequently Asked         Steven Mildward, Part A POE Project Administrator. Since
Questions                the J4 MAC was awarded, TrailBlazer has maintained an e-mail
                         address,, for providers to submit
                         questions. At this point, TrailBlazer has posted 45 questions
                         approved by CMS with another 20–25 in the approval process.
                         The FAQs are received through the Web site mail box. J4
                         inquiries are logged into a tracking system and then shared with
                         the appropriate department for input. The department submits
                         J4 input and the response is forwarded to CMS for approval
                         before they can be posted to the Web site.

                         Questions concerning LCDs make up about 38 percent of the
                         FAQs. The second largest category for FAQs is related to the
                         MAC changes and the third largest category is related to EDI
                         regarding electronic claims, electronic funds and remittance
                         advices. Mr. Mildward reviewed several of the FAQs of most
                         interest. Providers are encouraged to view all of the J4
                         published FAQs on the TrailBlazer J4 Implementation site.
Open Discussion          Angie Cooper, Part B POE Project Administrator. Ms.
                         Cooper opened the phone lines for questions.

                         Q. Will current Medicare legacy, individual and group numbers
                            remain the same or even be required on submitted claims?
                         A. TrailBlazer will continue to use the legacy, individual and
                            group PINs that were issued by the outgoing contractors.

                         Q. Will TrailBlazer require group and individual applications to
                            be revalidated?
                         A. CMS has instructed contractors to initiate revalidation for
                            specific providers. Revalidation requests have been initiated
                            by the legacy contractors and providers should comply with

Created by: ROB
Create date: 9/10/2007
                                                                                                               Responsible Person/
      Agenda Items                           Discussion/Minutes                              Action Required                         Due Date

                            any revalidation request that is initiated by the legacy
                            contractor. TrailBlazer has no current plans for full
                            revalidation of all J4 MAC providers, but will comply with any
                            future CMS revalidation directives.

                         Q. Will NPI data from Pinnacle be transferred to TrailBlazer or
                            will information have to be submitted again?
                         A. All NPI data from PECOS and the NPI crosswalk will
                            automatically transfer to TrailBlazer.

                         Q. Do you know when we can expect news on our IDs and
                            temporary passwords for Oklahoma/New Mexico?
                         A. The letters will be sent by the end of December.

                         Q. If we are currently submitting via GPNet with other
                            TrailBlazer payers, will we still be required for testing?
                         A. No. Testing is mainly required for communication
                            connection. If you are already submitting to GPNet, in the
                            early boarding phase you will more than likely keep your
                            existing Submitter ID. Currently an analysis is being done to
                            compare Submitter IDs from Pinnacle to TrailBlazer’s IDs.
                            So far there have been no duplications.

                         Q. If I have a group of providers that will be coming on in March
                            2008, on the 855I, what do you consider to be the current
                            date of information?
                         A. The cutover date is March 1. If you send the forms prior to
                            March 1, they should go to Pinnacle. If you send them
                            March 1 or after, they will go to TrailBlazer.

                         Q. Do you need the EFTs by January 31, 2008?
                         A. Yes. This will give us enough time to request further
                            information if needed and still make the deadline.

                         Q. For the current 139 consolidated LCDs (formerly known as
                            LMRPs) that are being posted to the J4 site on December
                            15, will the effective date be December 15, 2007, or 45 days

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                         A. The effective date on the policy will be the cutover date for
                            the segment. The cutover date for Part B Oklahoma and
                            New Mexico is March 1, 2008.

                         Q. Will TrailBlazer be accepting paper claims for Part B
                         A. If you are currently billing electronically, you will need to
                            continue to bill electronically.

                         Q. Can you do Part B CMS-1500 forms online?
                         A. The Part B system does not allow you to submit or do direct
                            data entry. This is not an available option in that standard

                         Q. Where do we get information on the GPNet?
                         A. GPNet information can be found on the EDI page of the
                            TrailBlazer J4 Implementation Web site. On the EDI page,
                            locate the GPNet Communications Manual under
                            Resources. This manual will give you step-by-step
                            instructions on how to upload and download files as well as
                            a copy of our response report. Also located under
                            Resources is the GPNet Edits Manual.
Next Meeting             The next teleconference is scheduled for January 7, 2008, from
                         10 a.m. – noon (CT).

Created by: ROB
Create date: 9/10/2007

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