TrailBlazer Loses Medicare Contract

TrailBlazer Health Enterprises' attempt to remain the Medicare administrative contractor for Texas failed earlier this month when the Government Accountability Office denied its appeal of the selection of another vendor. Novitas Solutions, formerly Highmark Medicare Services, will begin handling Medicare claims in Texas and six other states beginning later this year. The Centers for Medicare & Medicaid Services (CMS) announced in November it had awarded the contract to Highmark as part of its plan to reduce the number of Medicare administrator jurisdictions from 15 to 10 by 2016. 

Highmark changed its name to Novitas Solutions in January when Blue Cross and Blue Shield of Florida purchased it. Besides Texas, the company will handle claims in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, and Oklahoma. It now administers claims in Delaware, New Jersey, Pennsylvania, Maryland, and the District of Columbia. It also will be responsible for enrolling, educating, and auditing Medicare physicians and other health care professionals, and some key specialty functions, including processing Indian Health Service facility claims for the entire country and serving as the designated Medicare Parts A and B contractor for centralized billing by immunization clinics.

The transition is expected in late summer.

TrailBlazer's contract with CMS runs through August. TrailBlazer said any transition to Highmark "would include extensive communications with providers and other impacted parties about transition requirements and activities." 

Concerned over the change's impact on physician and patients, TMA and the Colorado, New Mexico, and Oklahoma state medical societies backed TrailBlazer's appeal. They wrote Acting CMS Administrator Marilyn Tavenner that the decision to change contractors was "ill considered, and will cause substantial disruption when consistency and stability is needed."

TMA's Payment Advocacy Department will work with Novitas, TrailBlazer, and CMS to make the transition as smooth as possible for physician practices and patients. TMA will provide more information in future issues of Action and Texas Medicine, and on the TMA website.


Action, March 15, 2012


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