Jurisdiction C: AAHomecare, Cigna discuss transition issues

Sunday, September 9, 2007

NASHVILLE, Tenn. -AAHomecare held a conference call with Cigna officials Aug. 29, addressing concerns over a backlog of claims that has dogged the Jurisdiction C Medicare Administrative Contractor (MAC) since it took over for Palmetto July 1.

"We felt compelled to express our strong concern with transition issues, and we are working with Cigna to make sure claims are processed on a timely basis," said Walt Gorski, vice president of government affairs for AAHomecare.

Providers are also having trouble getting through to Cigna on the phones, due to heavier than expected call volume, said Raul Lopez, director of operations for Miami Lakes, Fla.-based Bayshore Dura Medical, who sits on the Jurisdiction C Advisory Council.

"They expected 3,000 to 4,000 calls a day, and they are getting up in the 20,000s a day," said Lopez.

Exacerbating the problem: Providers in Virginia and West Virginia moved from Jurisdiction B to C, leading to further billing problems, said Stephanie Hess, secretary and regulatory co-chairwoman for the Virginia Association of Durable Medical Equipment Companies.

"Claims are being rejected for invalid reasons," she said. "CMN information, especially on oxygen, doesn't seem like it transitioned. For claims that were being paid through Jurisdiction B, now C is denying them and wanting copies of the CMNs."

Cigna has said it is working to fix the problems. The MAC said it planned to hire additional staff for the call center.