CMS Manual System
Department of Health &
Human Services (DHHS)
Pub 100-20 One-Time Notification
Centers for Medicare &
Medicaid Services (CMS)
Transmittal 431 Date: January 16, 2009
Change Request 6279
SUBJECT: Jurisdiction 3 A/B MAC Merge of the Part B Arizona, Montana and Utah CICS
Production and User Acceptance Testing Regions
I. SUMMARY OF CHANGES: In order to maximize efficiency and cost savings from the MAC
implementation, CMS needs to merge the Part B Arizona, Utah and Montana workloads into a single CICS
region for production, with a separate single CICS region for user acceptance testing (UAT).
New / Revised Material
Effective Date: June 1, 2009
Implementation Date: April 6, 2009
Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized
material. Any other material was previously published and remains unchanged. However, if this revision
contains a table of contents, you will receive the new/revised information only, and not the entire table of
contents.
II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated)
R=REVISED, N=NEW, D=DELETED-Only One Per Row.
R/N/D Chapter / Section / Subsection / Title
N/A
III. FUNDING:
SECTION A: For Fiscal Intermediaries and Carriers: Not Applicable.
SECTION B: For Medicare Administrative Contractors (MACs):
The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined
in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is
not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically
authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to
be outside the current scope of work, the contractor shall withhold performance on the part(s) in question
and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions
regarding continued performance requirements.
IV. ATTACHMENTS:
One-Time Notification
*Unless otherwise specified, the effective date is the date of service.
Attachment – One-Time Notification
Pub. 100-20 Transmittal: 431 Date: January 16, 2009 Change Request: 6279
SUBJECT: Jurisdiction 3 A/B MAC Merge of the Part B Arizona, Montana and Utah CICS
Production and User Acceptance Test Regions
Effective Date: June 1, 2009
Implementation Date: April 6, 2009
I. GENERAL INFORMATION
A. Background: When the J3 A/B Medicare Administrative Contractor (MAC) became operational,
its Part B workloads were set up in several different processing and testing regions. In order to
maximize efficiency and cost savings from the MAC implementation, CMS needs to merge the Part B
Arizona, Utah and Montana workloads into a single CICS region for production, with a separate single
CICS region for user acceptance testing (UAT).
The J3 MAC will continue to process its Part B North Dakota, South Dakota and Wyoming workloads
in a separate CICS production and UAT region. The Multi Carrier System (MCS) cannot accommodate
more than 4 state workloads in a single CICS region.
The assignment of Part B provider identification numbers (PINS) has traditionally been a contractor
activity. In the past, some contractors that processed multiple workloads may have assigned PINS
without regard to whether the same PIN was already being used in another CICS region under its
control. In addition, different contractors generally did not coordinate their assignment of PINS, so they
might have inadvertently assigned the same PIN to two different providers in different service areas.
This was not a concern as long as the CICS regions remained separate. However, a MAC cannot
accommodate more than one of the same PIN in a single merged CICS region. In this case, the Part B
Montana and Utah CICS regions contain duplicate PINS.
Change Request (CR) 6199 provides for an approach to address this issue. As explained in both that CR
and the following business requirements, the MCS maintainer will provide a program to identify
duplicate PINS within the CICS regions that will be merged, the J3 A/B MAC will assign replacement
PINS to both duplicate numbers, and the MCS maintainer will replace all references to the existing
duplicate PINS within MCS with those new numbers. This CR repeats all of the business requirements
from CR 6199 for informational purposes only and any BRs associated with CR 6199 will be handled as
part of that CR.
This is the first Part B merge that will utilize this methodology. In the future, we anticipate undertaking
additional Part B merges using the same MCS system changes needed for this merge.
The CMS Healthcare Integrated General Ledger Accounting System (HIGLAS) business owner is
currently developing a methodology to merge HIGLAS Organizations. Until that process has been
implemented, we only plan to merge CICS regions that have not yet been transitioned to HIGLAS. (The
Part B AZ, UT and MT Part B CICS regions have not yet been transitioned to HIGLAS.)
The J3A/B MAC contract is currently held by Noridian
Its address is:
901 40
th
Street South
Fargo, ND 58103
B. Policy: N/A
II. BUSINESS REQUIREMENTS TABLE
Use “Shall" to denote a mandatory requirement
Number Requirement
Shared-System
Maintainers
A
/
B
M
A
C
D
M
E
M
A
C
F
I
C
A
R
R
I
E
R
R
H
H
I
F
I
S
S
M
C
S
V
M
S
C
W
F
OTHER
6279.1 The EDS EDC shall create the necessary
CICS regions for both user acceptance
testing (UAT) and production to
accommodate the merge of the Part B
Arizona, Montana, and Utah workloads into
a single production and a single user
acceptance testing (UAT) region.
EDS EDC
6279.1.1 The EDS EDC shall provide all support
needed to successfully implement the new
merged production and test regions,
including (but not limited to) production
support, testing, the running of split/merge
and related software supplied by the MCS
maintainer, and coordination.
EDS EDC
6279.2 The MCS shared system maintainer shall
provide any necessary support to
accomplish the merge, including software to
perform the split/merge.
X
6279.3 The J3 A/B MAC shall serve as the project
lead. It shall coordinate and provide project
management, testing, and any other services
needed to successfully accomplish the
merge.
J3 A/B
MAC
6279.3.1 The J3 A/B MAC shall perform the testing
required to validate the merged production
region and the EDC shall support that
testing.
EDS EDC,
J3 A/B
MAC
6279.4 As per CR 6199, BR 6199.1 the MCS
maintainer shall provide the A/B MAC with
file compare software that will produce a
list of duplicate PINs found on the MCS
Provider Eligibility file between the
X J3 A/B
MAC
Number Requirement
Shared-System
Maintainers
A
/
B
M
A
C
D
M
E
M
A
C
F
I
C
A
R
R
I
E
R
R
H
H
I
F
I
S
S
M
C
S
V
M
S
C
W
F
OTHER
workloads scheduled to be merged.
6279.4.1 As per CR 6199, BR 6199.1.1, the software
referred to in BR 6279.4 shall allow the
A/B MAC to assign new numbers to those
duplicate PINS by updating a user
maintained DATAIN. The J3 A/B MAC
shall use this software to assign the
replacement PINs.
X J3 A/B
MAC
6279.4.2 As per CR 6199, BR 6199.2, the software
referred to in 6279.4 shall also run a
compare of the MCS duplicate PINs found
in the A/B MACs workloads with the A/B
MAC’s PECOS provider file. The J3 A/B
MAC shall ensure that this software is run.
X J3 A/B
MAC
6279.4.2.1 As per CR 6199, BR 6199.2.1, if after
performing BR 6279.4.2, the duplicate PIN
on the A/B MACs MCS master provider
file is found in any of the PECOS files
(V200 file) the PECOS record shall be
added to the report. The report shall
contain the following information:
duplicate PIN, plan code, and PIN status. If
the PIN is active, the field status shall be
blank. If the PIN is inactive, the field status
shall be “IN”.
X J3 A/B
MAC
6279.5 As per CR 6199, BR 6199.3, the MCS
maintainer shall create software that will
produce a file that contains only the
duplicate PINs from the PECOS file (as per
BR 6279.4.2) as well as the newly assigned
replacement PINs.
X
6279.5.1 As per CR 6199, BR 6199.3.1, The MCS
maintainer shall use the user maintained
input file created by the MAC and the MCS
provider file to create a crosswalk file to
PECOS containing the following comma
delimited data: CURRENT-PROV-
NUMBER, ENROLLMENT ID, PAC-ID,
CURR PIN END DATE, CARRIER-
CODE-STATE, MAC CARRIER ID
CODE, NEW-PROV-NUMBER, NEW-
PROV-EFT-DATE.
X
6279.5.2 As soon as possible and no later than 90
days prior to the effective date of the CR,
the J3 A/B MAC shall send a copy of the
file referred to in BR 6279.5.1 to the
J3 A/B
MAC
Number Requirement
Shared-System
Maintainers
A
/
B
M
A
C
D
M
E
M
A
C
F
I
C
A
R
R
I
E
R
R
H
H
I
F
I
S
S
M
C
S
V
M
S
C
W
F
OTHER
PECOS maintainer via
[email protected]
.
6279.6 The PECOS maintainer shall process the
MCS import file referred to in BR 6279.5.1
to both its CMS validation and CMS
production regions.
PECOS
6279.6.1 The PECOS maintainer shall process all
enrollment records pertaining to the MCS
import file referred to in 6279.5.1 regardless
of its current status (both “final” and “non-
final”) with the exception of enrollment
records with the status of “deleted”.
PECOS
6279.6.2 The PECOS maintainer shall end date all
practice locations associated to the
duplicate PINs identified in the import file
referred to in 6279.5.1. The PECOS shall
not change any end dates that had been
previously assigned to such PINs.
PECOS
6279.6.3 The PECOS Maintainer shall replace each
end-dated practice location with a current
copy of that practice location. Each newly
created practice location shall be an exact
copy of all data (sans duplicate PIN) of each
practice location that was end-dated. The
PECOS Maintainer shall then add the newly
assigned PIN to the practice location.
PECOS
6279.6.4 The PECOS Maintainer shall end-date the
duplicate PIN in both Section 1 (Medicare
ID) and Section 4 (Practice Location) for
each enrollment record identified as
belonging to a duplicate PIN as per BR
6279.5.1.
PECOS
6279.6.5 The PECOS Maintainer shall add the new
PIN to both Section 1 (Medicare ID) and
Section 4 (Practice Location) for each
enrollment record. If available, the effective
date of the new PIN shall be set to the
effective date of the duplicate PIN being
replaced. Note that while PECOS collects
the effective date for PINs, it does not
require an effective date. Therefore, an
effective date for the duplicate PIN may not
be available.
PECOS
6279.6.6 The PECOS Maintainer shall maintain the
relative order of practice location create
dates, within the same enrollment record,
PECOS
Number Requirement
Shared-System
Maintainers
A
/
B
M
A
C
D
M
E
M
A
C
F
I
C
A
R
R
I
E
R
R
H
H
I
F
I
S
S
M
C
S
V
M
S
C
W
F
OTHER
for practice locations associated to those
PINs received from MCS, as per 6279.5.1.
6279.6.7 PECOS shall not modify the format of the
current MCS export file generated nightly
by PECOS.
PECOS
6279.6.8 PECOS shall not programmatically re-
trigger enrollment records to MCS as part
of CR 6199.
PECOS
6279.6.9 PECOS shall not change the status of the
enrollment record prior to or after
processing is complete.
PECOS
6279.6.10 PECOS shall not process duplicate PINs on
enrollment records where the duplicate PIN
(Section 1) and associated practice
location(s) (Section 4) are both already end-
dated.
PECOS
6279.6.11 PECOS shall process duplicate PINs on
enrollment records where the duplicate PIN
(Section 1) is end-dated and exists on an
active practice location.
PECOS
6279.6.12 PECOS shall not specify a primary practice
location for Medicare Part B enrollment
records.
PECOS
6279.6.13 The PECOS Maintainer shall support a 2
month test window.
PECOS
6279.7 MCS shall utilize its split/merge software
logic to replace all references to the
duplicate PINS within MCS with
appropriate references to the newly
assigned replacement PINS.
X
6279.8 MCS shall assign the provider start date
belonging to the duplicate PIN to the newly
assigned replacement PIN.
X
6279.9 The J3 A/B MAC shall review and where
necessary update all interface and non-base
files & applications with appropriate
references to the newly assigned
replacement PINS, including but not limited
to its EDI front end and its free /low cost
EDI billing software.
J3 A/B
MAC
6279.10 As per CR 6199, BR 6199.5, MCS shall
modify its PECOS extract logic to bypass
the duplicate PINS that have been end dated
in PECOS so that MCS will not produce
merge errors for these PINS. (All other
PECOS end dated PINS shall continue to be
X
Number Requirement
Shared-System
Maintainers
A
/
B
M
A
C
D
M
E
M
A
C
F
I
C
A
R
R
I
E
R
R
H
H
I
F
I
S
S
M
C
S
V
M
S
C
W
F
OTHER
subjected to the merge error logic within
MCS.)
6279.11 As per CR 6199, BR 6199.6, MCS shall
provide a mechanism to prevent the J3 A/B
MAC from incorrectly adding the duplicate
PIN to the MCS provider file.
X
6279.12 As soon as possible and no later than 90
days prior to the effective date of the CR,
the J3 A/B MAC shall send a copy of the
file referred to in BR 6279.5.1 to the NPI
Crosswalk maintainer via
[email protected].
Please note that this is for informational
purposes only and that the actions being
taken by the PECOS maintainer will result
in appropriate updates being made to the
NPI crosswalk.
J3 A/B
MAC
NPI
CROSSWA
LK
Maintainer
6279.12.1 In addition to the newly assigned
replacement PINS, the NPI Crosswalk shall
continue to carry the duplicate PINS.
Please note that this will not impact
contractor operations or payment
NPI
CROSSWA
LK
Maintainer
6279.13 The MCS Maintainer shall provide the J3
A/B MAC with a listing of the data
elements for which it requires mappings to
the J3 A/B MAC’s current configuration.
X J3 A/B
MAC
6279.13.1 The J3 A/B MAC shall prepare mappings
between the existing production and UAT
regions and the configuration it wishes to
use in the new merged region. This
information shall be communicated to the
MCS maintainer via DATAINs provided
for in the MCS split/merge software.
J3 A/B
MAC
6279.13.2 The MCS maintainer shall use the mappings
supplied by the J3 A/B MAC to convert
history (including purged history that had
been converted to MCS) to reflect the
mappings to be used in the new merged
region.
X
6279.14 Following the merge, the J3 A/B MAC shall
continue to process and report upon the
workload using the appropriate MAC state
specific workload numbers.
J3 A/B
MAC
6279.15 Following the merge into the single CICS
production and UAT regions, all shared
BESS,
CAFM,
Number Requirement
Shared-System
Maintainers
A
/
B
M
A
C
D
M
E
M
A
C
F
I
C
A
R
R
I
E
R
R
H
H
I
F
I
S
S
M
C
S
V
M
S
C
W
F
OTHER
systems and CMS contractors shall continue
to successfully interact with the state
specific MAC workload numbers and the
newly assigned replacement PINS.
CERT,
CMIS,
CMS BDC,
COBA,
CROWD,
CSAMS,
DCS,
ECRS,
HCIS, IRIS,
LOLA,
NGD, the
NPI
crosswalk,
PECOS,
PIMR,
PORS,
PS&R, the
PSC,
PSOR,
PULSE,
REMAS,
and REMIS,
Maintianers
.
6279.16 MCS shall provide for the notification of
anyone querying the system with a deleted
duplicate PIN. If practical, the notification
should point to the appropriate replacement
PIN. If that is not practical, the notification
shall return both replacement PINS and the
J3 A/B MAC shall determine the
appropriate PIN.
X J3 A/B
MAC
III. PROVIDER EDUCATION TABLE
Number Requirement
Shared-System
Maintainers
A
/
B
M
A
C
D
M
E
M
A
C
F
I
C
A
R
R
I
E
R
R
H
H
I
F
I
S
S
M
C
S
V
M
S
C
W
F
OTHER
6279.17 At least 90 days prior to the effective date
of this CR, the J3 A/B MAC shall notify
each provider who will need to have its PIN
changed to the new PIN, and when it should
begin using it.
J3 A/B
MAC
IV. SUPPORTING INFORMATION
A. For any recommendations and supporting information associated with listed requirements, use
the box below:
Use "Should" to denote a recommendation.
X-Ref
Requirement
Number
Recommendations or other supporting information:
B. For all other recommendations and supporting information, use this space:
This CR is necessary in order for the CMS to realize significant additional efficiencies and cost
savings from the J3 A/B MAC transition.
V. CONTACTS
Pre-Implementation Contact(s): Scott Levine ([email protected] or 212-616-2337) and
Steven Felsenberg ([email protected] or 410-786-2693).
Post-Implementation Contact(s): Scott Levine ([email protected] or 212-616-2337) and
Steven Felsenberg ([email protected] or 410-786-2693).
VI. FUNDING:
A. Title XVIII contractors: N.A.
B. For Medicare Administrative Contractors (MAC):
The contractor is hereby advised that this constitutes technical direction as defined in your contract.
CMS does not construe this as a change to the Statement of Work (SOW). The contractor is not
obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically
authorized by the Contracting Officer. If the contractor considers anything provided, as described above,
to be outside the current scope of work, the contractor shall withhold performance on the part(s) in
question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal
directions regarding continued performance requirements.