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Intermediary-Carrier Directory
U.S. Department of Health and Human Services
|
Scott P. Serota
President & Chief Executive Officer PHONE:312-297-6010 |
Wilson Leong, Esq. CPA
Executive Director Prime Contract PHONE:312-297-5869 |
ALABAMA PART A PROVIDER SERVICE AREA: States of
Alabama, Iowa and South Dakota Special Claims: Home Health
PART B JURISDICTION: States of Alabama, Georgia,
Mississippi
Blue Cross and Blue Shield of Alabama
(d.b.a. - Cahaba Government Benefit Administrators)
PART A - AGREEMENT NO. HCFA 87-001-1.1
PART B - CONTRACT NO. HCFA 87-003-2
Charles R. Hartsell
President & COO Cahaba Government Benefit Administrators PHONE: 205-220-2126 EMAIL: chartsell@bcbsal.org |
Lynda Northcutt
Sr. Vice President Medicare Administration Cahaba Government Benefit Administrators P.O. Box 830139 Birmingham, AL 35283-0139 PHONE: 205-220-4835 FAX: 205-220-4841 EMAIL: lnorthcutt@bcbsal.org |
Robert Orr, Jr.
VP
Cahaba Government Benefit Administrators
P.O. Box 830139
Birmingham, Alabama 35283-0139
PHONE: 205-220-4835
EMAIL: rorr@bcbsal.org
PHONE: 205-220-2100
FAX: 205-220-4841
Web Site: www.cahabagba.com
ALABAMA OFFICE – Medicare Intermediary & Carrier
Beneficiary Customer Service – 1-800-292-8855
Provider Line - 1-866-539-5598
INTERNET: almedicare@bcbsal.org
Web Site: www.cahabagba.com
OVERNIGHT PACKAGES ONLY
Cahaba Government Benefit Administrators
Alabama Medicare Claims Administration
MSID-F00005
450 Riverchase Parkway East
Birmingham, AL 35244
PHONE: 205-220-4842
FAX: 205-220-4841
David Brown
Executive Director,Cahaba Resource Center
Cahaba Government Benefit Administrators
PHONE: 205-220-4099
EMAIL: dbrown@bcbsal.org
Leigh Forman
Executive Director, Part B Claims
Cahaba Government Benefit Administrators
PHONE: 912-921-3087
EMAIL: lforman@bcbsal.org
Susan Pretnar
Executive Director, Part A and RHHI Claims
Cahaba Government Benefit Administrators
PHONE: 515-471-7302
EMAIL: spretnar@cahabagba.com
John Cook, Jr.
Executive Director, Quality
PHONE: 601-977-5850
EMAIL: jwcook@cahabagba.com
ALABAMA OFFICE –
MSID-F00005
450 Riverchase Parkway East
Birmingham, AL 35244
P.O. Box 830139
Birmingham, AL 35283-1039
FAX: 205-220-4841
INTERNET: almedicare@bcbsal.org
Beneficiary Customer Service - 1-800-292-8855
Provider Line - 1-866-539-5598
GEORGIA OFFICE –
12052 Middleground Road, Suite A
Savannah, GA 31419-1699
FAX: 912-921-4635
INTERNET: gamedicare@bcbsal.org
Beneficiary Customer Service - 1-800-727-0827
Provider Line - 1-912-927-0934
MIDWEST OFFICE –
400 E. Court Avenue, Station 158
Des Moines, IA 50309-2017
FAX: 515-471-7222
INTERNET: iamedicare@cahabagba.com
Beneficiary Customer Service - 1-877-910-8139
Provider Customer Service - Home Health: 1-877-299-4500
Hospice: 1-866-539-5592
Other Providers: 1-877-567-3092
MSP (attorneys and insurers): 515-471-7400
MISSISSIPPI OFFICE –
775 Woodlanes Parkway
Ridgeland, MS 39157-5212
P.O. Box 22545
Jackson, MS. 39225-2545
FAX: 601-956-2738
INTERNET: msmedicare@cahabag.com
Beneficiary Customer Service - 1-800-682-5417
Provider Customer Service - 1-866-419-9454
ALASKA PART A PROVIDER SERVICE AREA - See Noridian Mutual Insurance Company (Blue Cross of
North Dakota)
PART B JURISDICTION - See Noridian Mutual Insurance Company
ARIZONA PART A PROVIDER SERVICE AREA : State of
Arizona
PART B JURISDICTION - See Noridian Mutual Insurance Company
BLUE CROSS AND BLUE SHIELD OF
ARIZONA, INC.
P.O. Box 37700
Phoenix, Arizona 85069
STREET ADDRESS:
2444 West Palmaritas Drive
Phoenix, Arizona 85021
PHONE: 602-864-4400
FAX: 602-864-4041
EMAIL: www.medicareaz.com
PART A- AGREEMENT NO. HCFA 87-001-1.2
Richard L. Boals
President and CEO PHONE: 602-864-4444 |
Susie Nash
Vice President of Federal Programs PHONE: 602-864-4423 �� |
� | |
Tony Astorga
Senior Vice President Claims and Federal Programs PHONE: 602-864-4676 |
Karen Abraham
Vice President of Finance PHONE: 602-864-5700 �� |
ARKANSAS PART A PROVIDER SERVICE AREA: State of
Arkansas and Rhode Island
PART B JURISDICTION: States of Arkansas , Louisiana,
Oklahoma, New Mexico, Eastern Missouri
ARKANSAS BLUE CROSS AND BLUE
SHIELD
A MUTUAL INSURANCE COMPANY
Street Address: 601 South Gaines Street
Little Rock, AR 72203
AR Medicare Services Operations
WEBSITES:
AR- www.arkmedicare.com
LA- www.lamedicare.com
OK- www.oknmmedicare.com
NM- www.oknmmedicare.com
MO- www.momedicare.com
RI- www.rimedicare.com
PART A - AGREEMENT NO. HCFA 87-001-1.3
PART B - CONTRACT NO . HCFA-87-004-2
Sharon K. Allen
President & COO PHONE: 501-378-2145 |
Dennis Robertson
Sr. Vice President Public Programs PHONE: 501-210-9035 |
Regina H. Favors
Vice President Public Programs-Operations PHONE: 501-210-9036 � | �
Charles Clem
Vice President Public Programs-Systems PHONE: 501-210-9076 � | ���
Teresa Milligan
Medicare Compliance Officer PHONE: 501-210-9078 � | ���
|
� | |
ARKANSAS PART A & B OPERATIONS
Kay Werner Director, Arkansas Part A & B Operations Phone: 501-210-9254 Amanda Crosby Director, Provider Audit and Reimbursement Phone: 501-918-7469 Barb Oberste Director, Medicare Integrity Programs Phone: 501-918-7418 Part A Provider: 1-866-548-0527 Part A Beneficiary: 1-877-356-2368 Part B Provider: 1-877-908-8434 Part B Beneficiary: 1-800-482-5525 |
Louisiana Part B Operations
8687 United Plaza Boulevard Baton Rouge, LA 70809 Margie Slaughter Director, Louisiana Part B Operations Phone: 225-231-2220 Provider: 1-877-567-7204 Beneficiary: 1-800-392-3070 |
�� | |
Rhode Island Part A and Part B Operations
86 Weybossett Providence, RI 02903-2800 Joan Costello Director RI Operations Phone:401-276-5830 Part A Provider: 1-866-339-3714 Part A Beneficiary: 1-800-662-5170 Part B Provider: 1-866-801-5304 Part B Beneficiary: 1-800-662-5170 |
Oklahoma/New Mexico Part B Operations
701 NW 63rd Oklahoma City, OK 73116 Curtis Blair Director, Oklahoma/New Mexico Operations Phone:405-841-6738 Lanny Day Director, Congressional Liaison** Phone:405-841-6738 ** For All Locations Provider: OK/NM 1-877-567-9230 Beneficiary: OK 1-800-522-9079 Beneficiary: NM 1-800-423-2925 |
�� | |
Eastern Missouri Part B Satellite Office
12755 Olive Street St Louis, Missouri 63141 PHONE: 314-212-1705 Provider: 1-866-539-5599 Beneficiary: 1-800-392-3070 |
CALIFORNIA PART A PROVIDER SERVICE AREA: United Government Services, LLC
PART B JURISDICTION: See National Heritage Insurance Company
COLORADO PART A PROVIDER SERVICE AREA - See TrailBlazer Health Enterprises, LLC and
Blue Cross and Blue Shield of South
Carolina (HHA only).
PART B JURISDICTION - See Noridian Mutual Insurance Co. (North
Dakota)
See Empire HealthChoice, Inc.
PART B JURISDICTION - See First Coast Service Options, Inc.
(First Coast Service Options)
DELAWARE PART A PROVIDER SERVICE AREA: See Empire HealthChoice, Inc.
PART B JURISDICTION - See (Texas) Trailblazer Health Enterprises, LLC
DISTRICT OF COLUMBIA PART A PROVIDER SERVICE AREA -
See Care First of Maryland
PART B JURISDICTION - See (Texas) Trailblazer Health Enterprises, LLC
FLORIDA PART A PROVIDER SERVICE AREA: State of
Florida
PART B JURISDICTION: State of Florida, Connecticut
FIRST COAST SERVICE OPTIONS, INC.
PART A - AGREEMENT NO. HCFA 87-001-1.10
PART B - CONTRACT NO. HCFA-87-009-2
MEDICARE
532 Riverside Avenue
Jacksonville, Florida 32202
PHONE: 904-791-6111
MEDICARE A & B BENEFICIARY-TOLL-FREE:
1-800-633-4227
MEDICARE B PROVIDER-TOLL-FREE: 1-877-847-4992
MEDICARE B PROVIDER - CSR CALLS - 1-866-454-9007
MEDICARE A PROVIDER ONLY - 1-877-602-8816
PART A Mailing Address (Claims and
Correspondence)
P.O. Box 2711 Jacksonville, FL � 32231-0021 INTERNET: Providers - floridamedicare.com Beneficiaries - medicarefla.com |
PART B Mailing Address (Claims)
P. O. Box 2525 Jacksonville, FL � 32231-0048 P.O. Box 2360 (Correspondence) Jacksonville, FL � 32231-0048 |
� | |
First Coast Services Options, Inc.
Curtis Lord CEO 532 Riverside Ave. Jacksonville, FL � 32202 PHONE: 904-791-8090 |
�� Patricia A. Williams President and COO P. O. Box 2711� 20 Tower Jacksonville, FL � 32202 PHONE: 904-791-8155 � |
Program Management A/B
Lamar James Vice President PHONE: 904-791-8358 |
Programs Safeguards A/B
Patricia Ainsley Vice President PHONE: 904-791-8136 |
321 Research Parkway
Meriden, CT � 06540-7148
BENEFICIARY - TOLL-FREE - 1-800-medicare
PROVIDER - TOLL FREE - 1-866-419-9455
CUSTOMER SERVICE: 203-639-3000
Mailing Address (Claims and Correspondence)
P. O. Box 9000 Meriden, CT � 06540 |
|
� | |
Program Management B
Lamar James Vice President PHONE: 904-791-8358 |
Program Safeguards B
Patricia Ainsley Vice President PHONE: 904-791-8136 |
� | |
Dr. Frank Delli Carpini
Interim Director PHONE: 203-634-5410 |
�
GEORGIA PART A PROVIDER SERVICE AREA: State of
Georgia
PART B JURISDICTION - See Blue Cross and Blue Shield of Alabama
BLUE CROSS AND BLUE SHIELD OF
GEORGIA, INC.
3350 Peachtee Road, N.E.
Atlanta, Georgia 30326
PHONE: 706-571-5371(Columbus)
PHONE: 404-842-8000(Atlanta)
FAX: 706-571-5431
INTERNET: www.georgiamedicare.com
PART A - AGREEMENT NO. HCFA 87-001-1.11
John Watts, Jr.
President and Chief Executive Officer PHONE: 404-842-8413 |
Pamela Bell
Vice President Medicare Part A 3350 Peachtree Road, NE P.O. Box 4445 PHONE: 404-842-8425/404-842-8643 FAX: 404-842-8588 |
�� | |
Part A Mailing Address (Claims and
Correspondence)
P.O. Box 9048 Columbus, GA 31908-9048 |
|
�� | |
MEDICARE A BENEFICIARY
TOLL-FREE:���1-800-322-3380
MEDICARE A PROVIDER TOLL-FREE: �������1-877-567-3095 MEDICARE A PROVIDER ENROLLMENT:�����1-866-305-0028 |
|
�� | |
Martha McCrary
Director Medicare Claims Operations 2357 Warm Springs Road Suite 214 Columbus, GA 31904 P.O. Box 9048 Columbus, GA 31908-9048 PHONE: 706-571-5260 |
Jim Dresslar
Director Provider Audit & Reimbursement 2357 Warm Springs Road Columbus, GA 31904 P.O. Box 9048 Columbus, GA 31908-9048 PHONE: 706-257-1080 |
HAWAII PART A PROVIDER SERVICE AREA - See United Government Services, LLC
PART B JURISDICTION - See Noridian Mutual Insurance Co. (North
Dakota)
IDAHO PART A PROVIDER SERVICE AREA - See Regence BlueCross BlueShield of
Oregon
PART B JURISDICTION - See Connecticut General Life Insurance
Company
ILLINOIS PART A PROVIDER SERVICE AREA: See Anthem Insurance Companies, Inc.
PART B JURISDICTION: See Wisconsin Physicians Service and National Heritage
Insurance Co.
INDIANA PART A PROVIDER SERVICE AREA: States of
Illinois, Indiana, Kentucky, Ohio
ANTHEM INSURANCE COMPANIES,
INC.
120 Monument Circle, Suite 200 Indianapolis, Indiana 46204 PHONE: 317-488-4400 (Corporate Office-AdminiStar, Inc.) FAX: 317-841-4691 |
� |
Medicare Operations:
ADMINASTAR FEDERAL, INC. 8115 Knue Road Indianapolis, IN � 46250 |
PART A -AGREEMENT NO. HCFA 88-001-1.16
Michael McCarron
President AdminaStar Federal, Inc. 8115 Knue Road Indianapolis, Indiana �46250 |
Sharon Weddel
Executive Director, Intermediary Operations |
INDIANA PART B JURISDICTION: States of Indiana,
Kentucky
DME REGIONAL CARRIER: District of Columbia,
Illinois, Indiana, Maryland,
Michigan, Minnesota, Ohio, Virginia,West Virginia, Wisconsin (PE)
ADMINASTAR FEDERAL,
INC.
8115 Knue Road
Indianapolis, Indiana 46250
PHONE: 317-841-4400 (Operations Office)
FAX: 317-841-4691
INTERNET: www.adminastar.com
PART B - HCFA CONTRACT NO. 88-011-2
DMERC CONTRACT: 500-93-BPO2
Michael McCarron, President
AdminaStar Federal Inc. 8115 Knue Road Indianapolis, Indiana 46250 |
Christine Beard
Executive Director, Carrier & DMERC Operations |
IOWA PART A PROVIDER SERVICE AREA: See Blue Cross and Blue Shield of Alabama
PART B JURISDICTION: See Noridian Mutual Insurance Co.(North
Dakota)
KANSAS PART A PROVIDER SERVICE AREA: State of Kansas
PART B JURISDICTION: States of Kansas, Western
Missouri and Nebraska
BLUE CROSS AND BLUE SHIELD OF
KANSAS, INC.
Street Address: 1133 SW Topeka Blvd.
Topeka, Kansas 66629
Post Office Box 239
Topeka, Kansas 66601
PHONE: 785-291-7000
FAX: 785-291-7098
Email:bc.medicare@bcbsks.com
PART A - AGREEMENT NO. HCFA 87-001-1.19
PART B - CONTRACT NO. HCFA-87-013-2
Mike Mattox
President & CEO |
William H. Pitsenberger
Sr. Vice President PHONE: 785-291-8704 |
Doug Scott
Chief Operating Officer PHONE: 785-291-7371 |
�
KENTUCKY PART A PROVIDER SERVICE AREA: See State of
Indiana, Anthem Insurance Companies,
Inc.
PART B JURISDICTION: See State of Indiana, AdminaStar Federal, Inc.
LOUISIANA PART A PROVIDER SERVICE AREA - See Blue Cross and Blue Shield of
Mississippi
PART B JURISDICTION - See Arkansas Blue Cross and Blue Shield
MAINE PART A PROVIDER SERVICE AREA: State of Maine,
State of Massachusetts
(SPECIAL CLAIMS: HHA, Provider-Based HHA/Hospice, RHC)
PART B JURISDICTION - See National Heritage Insurance Company
ANTHEM HEALTH PLANS OF MAINE
INC.
(d.b.a. Associated Hospital Service)
2 Gannett Drive South
Portland, Maine 04106-6911
PHONE: 207-822-7000
FAX: 207-822-7926 INTERNET:Medicare@bcbsme.com
PART A- AGREEMENT NO. HCFA 87-001-1.22
David Crowley
Executive Director - Medicare Operations |
Robert Baroutas, Director
Massachusetts Medicare
Audit Reimbursement Department
50 Salem Street, Building A, 2nd Floor
Lynnfield, Massachusetts 01940-2694
MARYLAND PART A PROVIDER SERVICE AREA: States of
Maryland and the District of Columbia
PART B JURISDICTION - See TrailBlazer Health Enterprises, LLC
CAREFIRST OF MARYLAND,
INC.
(d.b.a Blue Cross and Blue Shield of Maryland, Inc.)
10455 Mill Run Circle
Owings Mills, Maryland 21117
PHONE: 410-252-5310
FAX:410-561-7951
EMAIL: Medicare_A@CareFirst.com
PART A - AGREEMENT NO. HCFA 87-001-1.23
Mr. William L. Jews
President & CEO PHONE: 410-998-5252 |
Stephan W. Simms
Director of Intermediary Operations PHONE: 410-561-4270 FAX: 410-561-7951 |
MASSACHUSETTS PART A PROVIDER SERVICE AREA: See Anthem Health Plans of Maine, Inc.
PART B JURISDICTION: See National Heritage Insurance Company
MICHIGAN PART A PROVIDER SERVICE AREA - See: United Government Services, LLC
PART B JURISDICTION - See Wisconsin Physicians Service Insurance
Corporation
MINNESOTA PART A PROVIDER SERVICE AREA: See Noridian Mutual Insurance Company
PART B JURISDICTION: See Wisconsin Physicians Service
MISSISSIPPI PART A PROVIDER SERVICE AREA: States of
Mississippi, Louisiana, and Missouri
PART B JURISDICTION - See Blue Cross and Blue Shield of Alabama
BLUE CROSS AND BLUE SHIELD OF
MISSISSIPPI
(d.b.a. TriSpan Health Services)
Medicare Part A Intermediary
P.O. Box 23046
Jackson, Mississippi 39225-3046
(STREET ADDRESS)
1064 Flynt Drive
Jackson, Mississippi 39232
PHONE: 601-936-0105
FAX: 601-664-4214
INTERNET: : trispan@bcbsms.com
PART A - AGREEMENT NO. HCFA 87-001-1.27
Richard J. Hale
President & CEO |
Jeff Leber
Chief Financial Officer Government Programs and Benefits Administration |
William V. Morris III
Vice President Government Programs PHONE: 601-664-4570 FAX: 601-664-4214 |
MISSOURI PART A PROVIDER SERVICE AREA - See Blue Cross and Blue Shield of
Mississippi and Mutual of Omaha Ins.
Co.
PART B JURISDICTION - See Blue Cross and Blue Shield of Kansas,
Inc. for Western Missouri and Arkansas Blue Cross Blue Shield for
Eastern Missouri
MONTANA PART A PROVIDER SERVICE AREA: State of
Montana
PART B JURISDICTION: State of Montana
BLUE CROSS AND BLUE SHIELD OF
MONTANA, INC.
(PART A)
P.O. Box 5017
Great Falls, Montana 59403
STREET ADDRESS:
3360 Tenth Avenue, South
Great Falls, Montana 59403
PHONE: 406-791-4000 (Direct Dial)
FAX: 406-727-9355
INTERNET: ndrazich@bcbsmt.com
(PART B)
P.O. Box 4310
2501 Beltview
Helena, Montana 59604
FAX: 406-442-9968
INTERNET: thubbard@bcbsmt.com
PART A - AGREEMENT NO. HCFA 87-001-1.30
PART B - CONTRACT NO. HCFA-87-018-2
Peter J. Babin
President & CEO PHONE:406-444-8200 FAX: 406-447-8607 |
Mike Wagner
Vice President Federal Programs & Corporate Treasury |
Medicare A & B
(Medicare Coordinator) PHONE: 406-791-4152 A PHONE: 406-444-8356 B |
�� | ||
Dave Pfeifle
Medicare A Team Leader/ Audit Manager Supervisor Phone: 406-791-4152 |
Doris Hernandez
Part A Medicare Claims Phone: 406-791-4013 |
|
�� | ||
Lana Finch
Team Leader, Mediare Part B & Operations PHONE: 406-444-8503 |
Medicare B Receptionist
PHONE: 406-447-8713 |
Fred Olson
CMD and Team Leader PHONE:406-447-3557 |
�
NEBRASKA PART A PROVIDER SERVICE AREA:
State of Nebraska
PART B JURISDICTION - See Blue Cross and Blue Shield of Kansas,
Inc.
BLUE CROSS AND BLUE SHIELD OF
NEBRASKA
P.O. Box 24563
Omaha, Nebraska 68124-0563
STREET ADDRESS:
7261 Mercy Road
Omaha, Nebraska 68124
PHONE: 402-390-1800 (Switchboard)
FAX: 402-398-3640 (Corporate Office)
PART A - AGREEMENT NO. HCFA 87-001-1.31
Steve Martin
President & CEO |
Duane Wilson
Treasurer and Chief Financial Officer |
Barbra Buls
Vice President of Government Programs PHONE: 402-343-3366 FAX: 402-398-3640 |
NEVADA PART A PROVIDER SERVICE AREA - See United Government Services, LLC
PART B JURISDICTION - See Nordian Mutual Insurance Company
NEW HAMPSHIRE PART A PROVIDER SERVICE AREA: States
of New Hampshire and Vermont
(SPECIAL CLAIMS: RHC )
PART B JURISDICTION - See National Heritage Insurance Company
ANTHEM HEALTH PLANS OF NEW
HAMPSHIRE, INC.
(d.b.a. Anthem Blue Cross and Blue Shield of New Hampshire)
3000 Goffs Falls Road
Manchester, New Hampshire 03111-0001
PHONE: 603-695-7000
FAX: 603-695-7741 (notify recipient of fax)
PART A - AGREEMENT NO. HCFA 87-001-1.32
David Crowley
Executive Director Medicare Operations |
�
NEW JERSEY PART A PROVIDER SERVICE AREA
: See Blue Cross Blue Shield of Tennessee (d.b.a. Riverbend Government
Benefits Administrators)
PART B JURISDICTION - See Empire HealthChoice, Inc.
NEW MEXICO PART A PROVIDER SERVICE AREA: See Texas - TrailBlazer Health Enterprises,
LLC
and Blue Cross and Blue Shield of South
Carolina (HHA claims only)
PART B JURISDICTION - See Arkansas Blue Cross and Blue Shield A
Mutual Insurance Company
NEW YORK PART A PROVIDER SERVICE AREA: States of New
York, Delaware and Connecticut
PART B JURISDICTION: Counties of Bronx, Columbia,
Delaware, Duchess, Greene, Kings, Nassau, New York, Orange, Putnam,
Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester. (Also -
See HealthNow New York Inc. and Group Health Incorporated)
EMPIRE HEALTHCHOICE ASSURANCE,
INC.
(d.b.a. Empire Medicare Services)
PART A - AGREEMENT NO. HCFA 87-001-1.38
PART B - CONTRACT NO. HCFA 87-021-2
FAX: 914-248-2948
INTERNET: lloyd.kasow@empireblue.com
Michael A. Stocker, M.D.
President and CEO 11 West 42 Street 18th Floor New York, NY 10036 |
William Foley
Vice President Medicare Services 2651 Strang Blvd. Yorktown Heights, NY 10598 PHONE:914-248-2852 FAX: 914-248-2948 |
Gloria McCarthy
Executive Vice President and Chief Operating Officer 11 West 42 Street New York, NY 10036 |
��� | ||
Christine Thomas
Assistant Vice President Public Relations and Medicare Part A Operations 400 South Salina Street Syracuse, NY 13202 PHONE: 315-442-4530 |
Kathy Doolittle
Assistant Vice President Medicare Part B Program Management 2651 Stang Blvd. Yorktown Heights, NY 10598 PHONE: 914-248-2865 |
�
NEW YORK PART B JURISDICTION
The State of New York (except for the Counties served by Empire
HealthChoice, Inc. and Group Health, Inc.)
DME REGIONAL CARRIER: Connecticut, Delaware, Maine,
Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New
York, Pennsylvania (PE)
HEALTHNOW NEW YORK INC.
1901 Main Street Buffalo, New York 14208 |
P.O. Box 80 Buffalo, New York 14240-0080 |
PHONE: 716-887-6900 (Buffalo) FAX: 716-887-8548 (Buffalo) |
PART B - CONTRACT NO. HCFA 87-022-2
DMERC: 01-AGG-2000
James A. Cardone
Executive Vice President Operational Support Services, Chief Financial Officer and Treasurer PHONE: 716-887-2025 E-MAIL: Cardone.James@HealthNow.org William T. Wickis Sr. Vice President Customer Services and Claims Operations PHONE: 716-887-8940 E-MAIL: Wickis.William@HealthNow.org Alphonso O'Neil-White Executive Vice President, General Counsel and Corporate Secretary PHONE: 716-887-8508 E-MAIL: O'Neil-White.Alphonso@HealthNow.org |
UPSTATE MEDICARE DIVISION
HealthNow New York Inc. 33 Lewis Road Binghamton, New York 13905 |
P.O. Box 5236 Binghamton, New York 13902-5236 |
PHONE: 607-766-6000 (UMD)
FAX: 607-766-6395 (UMD) |
|
Donna M. Przybysz
Vice President and Chief Operating Officer Upstate Medicare Divison & DMERC PHONE: 607-766-6270 E-MAIL: Przybysz.Donna@HealthNow.org |
DMERC
(See Upstate Medicare Divison—Binghamton)
NORTH CAROLINA PART A PROVIDER SERVICE AREA: See Blue Cross and Blue Shield of South
Carolina
PART B JURISDICTION - See Connecticut General Life Insurance
Company
NORTH DAKOTA PART A PROVIDER SERVICE AREA: State of
North Dakota, Minnesota, Washington, Alaska
PART B JURISDICTION: States of North Dakota, South
Dakota, Wyoming, Iowa, Colorado, Northern Marianna Islands, American
Samoa, Guam, Washington, Hawaii, Oregon, Alaska, Arizona, Nevada
NORIDIAN MUTUAL INSURANCE
COMPANY
4305 13th Avenue, S.W.
Fargo, North Dakota 58103
PHONE: 701-282-1100
FAX: 701-282-1002
www.noridian.com/medweb
PART A - AGREEMENT NO. HCFA 87-001-1.44
PART B - CONTRACT NO. HCFA 87-023-2
Michael Unhjem
President & CEO |
Jay Martinson
Vice President PHONE: 701-282-1439 |
�
OHIO PART A PROVIDER SERVICE AREA
: See State of Indiana, Anthem Insurance
Companies Inc.
PART B JURISDICTION - See Blue Cross and Blue Shield of South
Carolina
OKLAHOMA PART A PROVIDER SERVICE AREA: State of
Oklahoma
PART B JURISDICTION - See Arkansas Blue Cross and Blue Shield a
Mutual Insurance Company
GROUP HEALTH SERVICE OF OKLAHOMA,
INC.
(d.b.a. BLUE CROSS AND BLUE SHIELD OF OKLAHOMA)
1215 South Boulder Avenue
Tulsa, Oklahoma 74119
PHONE: 918-560-3000
FAX: 918-560-3506
INTERNET:medicare@bcbsok.COM
PART A - AGREEMENT NO. HCFA 87-001-1.52
Ronald F. King
President, CEO PHONE: 918-560-2195 |
Ms. Garoldine Webb
Vice President and Director of Government Programs PHONE: 918-560-2090 FAX: 918-560-3506 |
�
OREGON PART A PROVIDER SERVICE AREA: States of
Oregon, Idaho and Utah, also Clark County in the State of Washington
PART B JURISDICTION - See Noridian Mutual Insurance Company
REGENCE BLUECROSS BLUESHIELD
OF OREGON
200 S.W. Market Street
Portland, Oregon 97201
OR
P.O. Box 8110
Portland, Oregon 97207-8110
PHONE: 503-721-7116
FAX: 503-228-3304
INTERNET: MEDICARENW@REGENCE.COM
PART A -AGREEMENT NO. HCFA 87-001-1.53
Dr. Bart McMullan
President Regence BlueCross BlueShield of Oregon PHONE: 503-225-5351 |
Steve Hooker
Senior Vice President Regence BlueCross BlueShield of Oregon Internal Operations P. O. Box 1271 Portland, Oregon 97201-1271 PHONE: 503-225-5945 FAX: 503-225-4800 |
Joy Bahnemann
Vice President Medicare Northwest P. O. Box 8110 Portland, Oregon 97207-8110 PHONE: 503-721-7115 FAX: 503-228-3304 |
�
PENNSYLVANIA PART A PROVIDER SERVICE AREA:
Pennsylvania (SPECIAL CLAIMS: RHC).
HIGHMARK INC.
(d.b.a. Veritus Medicare Services)
120 Fifth Avenue, Suite P5101
Pittsburgh, Pennsylvania 15222-3099
PHONE: 412-544-7000
FAX: 412-544-8054
INERNET: veritusmedicare@highmark.com
Beneficiary Calls Only: 1-800-853-1419
Web Address: www.veritusmedicare.com
PART A - AGREEMENT NO. HCFA 87-001-1.56
Kenneth Melani, M.D.
President & CEO Highmark Inc. PHONE: 412-544-8202 |
Robert C. Gray
Executive Vice President Finance & Subsidiary Services Highmark Inc. Camphill, PA PHONE: 717-763-6274 |
�� | |
Dave O'Brien
Executive Vice President Government Services Highmark Inc. PHONE:412-544-8870-Pittsburgh PHONE:717-763-6568-Camphill |
Address all technical and
procedural correspondence to: Stephen Walker Vice President Government Business Unit 120 Fifth Avenue Suite P5101 Pittsburgh, PA 15222-3099 PHONE: 412-544-1961 FAX: 412-544-1971 |
�
PENNSYLVANIA PART B JURISDICTION
: State of Pennsylvania
HIGHMARK INC.
(d.b.a. HGSAdministrators)
P.O. Box 890065
Camp Hill, Pennsylvania 17089-0065
FOR EXPRESS MAIL:
1800 Center Street
Camp Hill, Pennsylvania 17089
PHONE: 1-800-662-0849 (Center Street) FAX: 717-302-3710 (Center Street)
INTERNET:www.hgsa.com
PART B - CONTRACT NO. HCFA 87-025-2
Kenneth Melani, M.D.
President & CEO Highmark Inc. PHONE: 717-302-3712 |
Robert C. Gray
Executive Vice President Finance & Subdisiary Services Pittsburgh Office Highmark Inc. 120 Fifth Avenue FAP 3116 Pittsburgh, PA. 15222 PHONE: 412-544-8043 Camp Hill Office HGSAdministrators P.O. Box 890089 Camp Hill, PA. 17089-0089 PHONE: 717-302-4387 |
��� | |
David M. O'Brien
Executive Vice President Government Services Pittsburgh Office Highmark Inc. 120 Fifth Avenue Pittsburgh, PA 15222 PHONE: 412-544-5250 Camp Hill Office HGSAdministrators P.O. Box 890089 Camp Hill, PA. 17089-0089 PHONE: 717-302-3865 |
Patrick M. Kiley
Vice President & Principal Officer HGSAdministrators PHONE: 717-302-3707 |
� | |
Andrew Bloschichak, M.D. MBA
Vice President Carrier Medical Director HGSAdministrators Program Safeguards PHONE: 717-302-4198 |
PUERTO RICO PART A PROVIDER SERVICE: See Cooperativa de Seguros de Puerto Rico
PART B JURISDICTION: Puerto Rico and U.S. Virgin
Islands
TRIPLE-S, INC.
Box 71391
San Juan, Puerto Rico 00936-1391
STREET ADDRESS:
1441 F.D. Roosevelt Avenue
Caparra, Puerto Rico 00920
PHONE: 787-749-4949 (Switch Board)
Community Relations (Medicare)
Providers: 787-749-4232
Provider Toll Free: 1-877-715-1921
Beneficiaries: 787-749-4900
Beneficiary Toll Freeline: 787-981-7015
FAX: 787-749-4900
INTERNET: mortiz@triples-med.org
Website: www.triples-med.org
PART B- CONTRACT NO. HCFA 87-033-2
Mr. Ramon Ruiz
President and Chief Executive Officer, Triples, Management Corp. PHONE: 787-749-4113 FAX: 787-749-4091 |
Mrs. Socorro Rivas
President and Chief Executive Officer Triple S, Inc. PHONE: 787-749-4118 FAX: 787-706-4001 |
��� | |
Mr. Carlos Gonzales, Esq.
Assistant Vice President Medicare PHONE: 787-277-6691 FAX: 787-749-4092 |
Mrs. Gloria Lebrón, Esq.
Vice President, Medicare PHONE: 787-749-4083 FAX: 787-749-4092 |
:See State of Arkansas - Arkansas Blue Cross and Blue Shield
PART B JURISDICTION: State of Arkansas - Arkansas Blue Cross and Blue Shield
� �
: State of South Carolina and North Carolina
Regional Home Health Intermediary (RHHI) Hospice:
Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky,
Louisiana, Ohio, Mississippi, New Mexico, North Carolina, Ohio,
Oklahoma, South Carolina, Tennessee, Texas
PART B JURISDICTION: State of South Carolina, Ohio, West Virginia
DME REGIONAL CARRIER: : Alabama, Arkansas, Colorado, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, (PE)
Statistical Analysis Durable Medical Equipment Carrier
(SADMERC)
National Supplier Clearinghouse (NSC)
BLUE CROSS AND BLUE SHIELD
OF SOUTH CAROLINA
(d.b.a. PALMETTO GBA) Executive Offices: 17 Technology Circle Columbia, South Carolina 29203-9511 Operations Offices: P. O. Box 100190 Columbia, South Carolina 29202-3190 PHONE: 803-735-1034 FAX: 803-935-0081 INTERNET: ROSE.VOYLES@Palmetto GBA.COM |
Overnight Mail
2300 Springdale Drive Building One Camden, SC 29020 |
PART A - AGREEMENT NO. HCFA 87-001-1.59
PART B - Contract No. HCFA 87-027-2
PART B - Contract - RRB - 00RRB005
DMERC - Contract - HCFA 500-93-BPO-3
William R. Horton
President Government Programs Division I-20 at Alpine Road Mail Code: AA-X30 Columbia, SC 29219 PHONE: 803-788-4138 FAX: 803-736-9289 |
Bruce W. Hughes
Executive Vice President & COO 17 Technology Circle Mail Code: AG-A03 Columbia, SC 29203-9511 PHONE: 803-763-7130 Columbia, SC 29223 FAX: 803-935-0081 |
��� | |
Roz Catoe
Vice President Processing & Customer Service 17 Technology Circle Mail Code: AG-A05 Columbia, SC 29203-9511 PHONE: 803-763-5086 FAX: 803-935-0176 |
Neal Burkhead Vice President Medicare Integrity Program 17 Technology Circle Mail Code: AG-A11 Columbia, SC 29203-9511 PHONE: 803-763-1535 FAX: 803-935-0176 |
��� | |
Ann Archibald
Vice President Compliance Officer 17 Technology Circle Mail Code: AG-A02 Columbia, SC 29203-9511 PHONE: 803-763-8700 FAX: 803-763-7115 |
Dickie Butler
Vice President Systems/EDI 17 Technology Circle Mail Code: AG-A08 Columbia, SC 29203-9511 PHONE: 803-763-1077 FAX: 803-935-1411 |
��� | |
Durable Medical Equipment ��� | |
Robin Spires Assistant Vice President DMERC Operations 17 Technology Circle Mail Code: AG-A13 Columbia, SC 29203-9511 Phone: 803-763-5704 Fax: 803-935-1411 |
Jean Catalano
Assistant Vice President Railroad Medicare Operations 2743 Perimeter Parkway Building 200, Suite 400 Augusta, GA 30909 Phone: 706-855-3130 Fax: 706-855-3132 |
��� | |
Mike Barlow
Vice President Ohio/WV Operations 3400 South Park Place Suite F Grove City, Ohio 43123-4846 Phone: 614-277-6400 Fax: 614-277-6803 |
Joe Wright
Vice President CFO 17 Technology Circle Mail Code: AG-A15 Columbia, SC 29203-9511 Phone: 803-763-5544 Fax: 803-935-0176 |
Elaine Meyers Assistant Vice President Part A/RHHI Operations 17 Technology Circle Mail Code: AG-13 Columbia, SC 29203-9511 Phone: 803-763-5505 Fax: 803-935-1411 |
SOUTH DAKOTA - PART A PROVIDER SERVICE AREA - See
Blue Cross and Blue Shield of Alabama
PART B JURISDICTION- See North Dakota, Noridian Mutual Insurance
Company
TENNESSEE PART A PROVIDER SERVICE AREA: State of
Tennessee, New Jersey (SPECIAL CLAIMS: RHC, CSC, OPT, HL, LPIC)
PART B JURISDICTION - See Connecticut General Life Insurance
Company
BLUE CROSS BLUE SHIELD OF
TENNESSEE
(d.b.a. Riverbend Government Benefits Administrator)
801 Pine Street
Chattanooga, Tennessee
37402
Medicare Address: 730 Chestnut Street Chattanooga, TN 37402
PHONE: (Medicare Beneficiary Toll Free) 866-641-2007
Provider Line: 877-296-6189 (toll free)
FAX: 423-752-6518
INTERNET:sharon_cheek@bcbst.com
PART A - AGREEMENT NO. HCFA 87-001-1.60
Vicky Gregg
President & COO |
Ann Keown
Vice President Phone: 423-755-5783 Fax: 423-763-3537 |
David Jackson
Director Government Programs Medicare Integrity Program and Reimbursement Phone:423-755-5806 |
: State of Texas, New Mexico and Colorado
PART B JURISDICTION: States of Texas, Maryland,
Delaware, District of Columbia, City of Alexandria, Arlington and
Fairfax Counties in Virginia (Special Claims: RHC), Virginia
TRAILBLAZER HEALTH ENTERPRISES,
LLC
P.O. Box 660156
Dallas, Texas 75266-0156
STREET ADDRESS:
8330 LBJ Freeway
Executive Center 3
Dallas, Texas 75243
PHONE: 469-372-1816
FAX: 469-372-1765
INTERNET-TX: tb.mail@trailblazerhealth.com
PART A - AGREEMENT NO. HCFA 87-001-1.62
PART B - CONTRACT NO. HCFA 87-029-2
Ms. Marti Mahaffey
Executive Vice President and COO
PHONE: 469-372-1701
�See Regence Blue Cross Blue Shield of
Oregon
PART B JURISDICTION: State of Utah
REGENCE BLUE CROSS AND BLUE
SHIELD OF UTAH
2890 East Cottonwood Parkway
Salt Lake City, Utah 84121
OR
P.O. Box 30269
Salt Lake City, Utah 84130-0269
PHONE: 801-333-2000
FAX: 801-333-6505
INTERNET:ut.medicaregeneral@regence.com
PART B - CONTRACT NO. HCFA 87-030-2
Scott Ideson
President PHONE: 801-333-5664 |
Joy Bahnemann
Vice President Government Programs P.O. Box 8110 Portland, Oregon 97207-8110 PHONE: 503-721-7056 |
�� | |
John Mitchell
Assistant Director Medicare B PHONE: 801-333-5225 |
- See Anthem Health Plans of New
Hampshire, Inc.
PART B JURISDICTION - See National Heritage Insurance Company
VIRGINIA PART A PROVIDER SERVICE AREA: See United Government Services, LLC
PART B JURISDICTION - TrailBlazer Health Enterprises, LLC
WASHINGTON PART A PROVIDER SERVICE AREA: See Noridian Mutual Insurance Company(Blue Cross Blue Shield of North Dakota)
PART B JURISDICTION - See Noridian Mutual Insurance Company(Blue Cross Blue Shield of North Dakota)
WEST VIRGINIA PART A PROVIDER SERVICE AREA -
See United Government Services, LLC
PART B JURISDICTION - See Blue Cross and Blue Shield of South
Carolina
WISCONSIN PART A PROVIDER SERVICE AREA: States of
Wisconsin, Michigan, Virginia, West Virginia, California, Nevada,
Guam, Northern Mariana Islands and American Samoa (SPECIAL CLAIMS:
HHA, Hospice, FQHC)
PART B JURISDICTION - See Wisconsin Physicians Service Insurance
Corporation
United Government Services, LLC
401 West Michigan Street
Milwaukee, Wisconsin 53203-2804
PHONE: 414-226-6203
INTERNET: www.ugsmedicare.com
FAX: 414-226-5226
Beneficiary Inquiries | |
---|---|
Milwaukee Office | 1-800-531-9695 (Wisconsin) |
1-866-804-0686 (Michigan) | |
Roanoke Office | 1-877-768-5471 |
Camarillo Office |
1-866-804-0684
1-866-264-4990 (Hawaii) |
Provider Inquiries | |
Milwaukee Office: | 1-877-309-4290 (Wisconsin) |
1-866-419-9462 (Michigan) | |
Roanoke Office: | 1-877-908-8474 |
Camarillo Office: |
1-866-380-4745
1-866-849-7244 (Hawaii) |
PART A - AGREEMENT NO. HCFA 87-001-1.70
Sally T. Wood
President United Government Services, LLC PHONE: 414-226-2813 |
Janine Harris
Vice President, Human Resources and Administration United Government Services, LLC. Phone: 414-226-5160 |
� | |
Timothy F. Cullen
Chairman, Government Health Services, LLC PHONE: 414-226-6004 |
Todd Reiger
Director of Finance United Government Services, LLC. Phone: 414-226-5606 |
�� | |
Cheryl Leissring
Compliance Officer & Director of Internal Audit United Government Services, LLC. Phone: 414 226-5884 |
|
�� | |
Liz Bartlett
Vice President & General Counsel United Government Services, LLC. Phone: 414-226-6777 |
|
�� | |
Steve Holubowicz
Vice President of Program Safeguards United Government Services, LLC. PHONE: 414-226-6991 |
|
�� | |
Shig Kimoto
Vice President, Information Technology United Government Services, LLC. Phone: 805-367-1010 |
WYOMING PART A PROVIDER SERVICE AREA: State of
Wyoming
PART B - See Nordian
Mutual Insurance Company
BLUE CROSS AND BLUE SHIELD OF
WYOMING
4000 House Avenue
Cheyenne, Wyoming 82001
OR
P.O. Box 908
Cheyenne, Wyoming 82003-0908
PHONE: 307-432-2860
FAX: 307-432-2901
INTERNET: jeff.beuchel@bcbswy.com
PART A - AGREEMENT NO. HCFA 87-001-1.71
Tim Crilly
President Medicare Coordinator PHONE: 307-432-3022 |
Jeffrey Beuchel
Director Medicare PHONE: 307-432-2848 |
SECTION III
COMMERCIAL AND INDEPENDENTS - PART A & B
COOPERATIVA DE SEGUROS DE
VIDA DE PUERTO RICO
GPO Box 363428
San Juan, Puerto Rico 00936-3428
STREET ADDRESS:
400 Americo Miranda Avenue
San Juan, Puerto Rico 00927
PART A - AGREEMENT NO. HCFA 87-326-1
PHONE: 787-758-9733(switchboard)
FAX: 787-756-8199
PART A PROVIDER SERVICE AREA: Puerto Rico and U.S. Virgin Islands
Mr. Carlos Fernández
President PHONE: 787-758-7854 |
Jose A. Brull
Vice President, Medicare PHONE: 787-763-2053 |
�� | |
Ms. Alba Cosme
Assistant Vice President Medicare Operations PHONE: 787-758-8469 |
William Zayas
Assistant Vice President Audit and Reimbursement PHONE: 787-765-2570 |
CONNECTICUT GENERAL LIFE INSURANCE
COMPANY (CGLIC), a CIGNA Company
Hartford, Connecticut 06152
PHONE: 615-244-5600
FAX: 615-782-4445
EMAIL: cignapartb@cigna.com
EMAIL: cignadmerc@cigna.com
INTERNET: www.cignamedicare.com
PART B - CONTRACT NO. HCFA 91-330-2
DMERC - CONTRACT No. 500-93-BPO-4
PART B JURISDICTION: States of Idaho, North Carolina,
Tennessee
DME REGIONAL CARRIER: Alaska, Arizona, California,
Guam, Hawaii, Idaho, Iowa, Kansas, Mariana Islands, Missouri, Montana,
Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah,
Washington, Wyoming (PE)
John F. Hoey
Assistant Vice President, CIGNA HealthCare, Medicare Administration Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4571 FAX: 615-782-4695 John.Hoey@cigna.com |
Ms. Jean Rush
Vice President, Medicare Contract Service MS C301 900 Cottage Grove Road Hartford, CT 06142 PHONE: 860-226-4690 FAX: 860-572-5066 |
� | |
CLAIMS SYSTEMS
William Swanke Assistant Vice President CIGNA Systems Two Vantage Way Metro Exchange Building Nashville, TN 37228 PHONE: 615-782-4672 FAX: 615-782-0187 Bill.swanke@cigna.com |
|
� | |
DURABLE MEDICAL EQUIPMENT
Kathy Filbert Assistant Vice President CIGNA Healthcare Medicare Administrator DMERC Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4424 FAX: 615-782-4626 Kathy.Filbert@cigna.com |
|
�� | |
Idaho, Tennessee, North Carolina �� | |
Darrell Tackett
Assistant Vice President, Part B Operations Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4525 FAX: 615-782-4627 Darrell.tackett@cigna.com |
|
�� | |
Jeff Chambers
Assistant Vice President, Finance Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4676 FAX: 615-782-4622 Jeff.Chambers@cigna.com |
|
�� | |
Brian Setzer
Assistant Vice President, Strategic Initiatives Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4618 FAX: 615-782-4445 Brian.setzer@cigna.com |
|
�� | |
Melissa Lamb
Benefit Integrity Manager Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4527 FAX: 516-782-4446 Melissa.Lamb@cigna.com |
|
�� | |
Michael Logan
Director of Compliance (interim) Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4595 FAX: 615-782-0182 Michael.Logan@cigna.com |
|
�� |
�
GROUP HEALTH INCORPORATED
25 Broadway
New York, New York 10004
PHONE: 646-458-6600
FAX: 646-458-6761
PART B - CONTRACT NO. HCFA 87-320-2
PART B JURISDICTION: Queens County, New York
Peter S. Moore
Vice President PHONE: 646-458-6601 |
|
�� | |
Sean Martinez
Director Community Relations PHONE: 646-458-6622 FAX: 646-458-6756 |
Jim Brady
Director of Medicare Operations Program Evaluation and Integrity PHONE: 646-458-6682 FAX: 646-458-6764 |
HAWAII MEDICAL SERVICE ASSOCIATION
PART A PROVIDER SERVICE AREA: United Government Services, LLC
PART B Jurisdiction: See North Dakota - Noridian Mutual Insurance Company
UNITED HEALTH CARE INSURANCE COMPANY
PART A PROVIDER SERVICE AREA: See Empire HealthChoice, Inc. and United Government Services, LLC
PART B JURISDICTION: See Blue Cross and Blue Shield
of Florida (Connecitut), See Wisconsin Physicians Services
(Minnesota), See Blue Cross and Blue Shield of Alabama (Mississippi),
See TrailBlazer Health Enterprises, LLC (Virginia) - DME Reg. Carrier,
See HealthNow New York Inc.
MUTUAL OF OMAHA INSURANCE COMPANY
P.O. Box 1602
Omaha, Nebraska 68131-3492
STREET ADDRESS:
Mutual of Omaha Plaza
Omaha, Nebraska 68175
PHONE: 402-351-2860
FAX: 402-351 8047
INTERNET: WWW.MUTUALMEDICARE.COM
PART A - AGREEMENT NO. HCFA 87-319-1
PART A PROVIDER SERVICE AREA: Available in all states
Rick Reeves
Vice President and Director of Medicare Mutual of Omaha P.O. Box 1602 Omaha, NE 68101 PHONE: 402-351-2940 FAX: 402-351-8796 EMAIL: RICK.REEVES@MUTUALOFOMAHA.COM |
�� |
Elizabeth M. Powers
First Vice President Medicare Admin. Systems Mutual of Omaha P.O. Box 1602 Omaha, NE 68101 PHONE: 402-351-2570 FAX: 402-351-8047 EMAIL: LIZ.POWERS@MUTUALOFOMAHA.COM |
�� |
Shelly Foxworthy
First Vice President Audit & Reimbursement Mutual of Omaha P.O. Box 1604 Omaha, NE 68101 PHONE: 402-351-5377 FAX: 402-351-8796 EMAIL: SHELLY.FOXWORTHY@MUTUALOFOMAHA.COM |
�� |
Patricia Allmon
First Vice President Medicare Claims Program Mutual of Omaha Ins. Co. P.O. Box 1602 Omaha, NE 68101 PHONE: 402-351-3205 FAX: 402-351-8047 EMAIL: TRISH.ALLMON@MUTUALOFOMAHA.COM |
�� |
Karen Alexander
First Vice President Quality Improvement Programs Mutual of Omaha Ins. Co. P.O. Box 1602 Omaho, NE 68101 PHONE: 402-351-4237 FAX: 402-351-5931 EMAIL: KAREN.ALEXANDER@MUTUALOFOMAHA.COM |
�� |
Janet Kyle
First Vice President Finance Mutual of Omaha Ins. Co. P.O. Box 1602 Omaho, NE 68101 PHONE: 402-351-6940 FAX: 402-351-8047 EMAIL: JANET.KYLE@MUTUALOFOMAHA.COM |
�� |
Charles Hagen
First Vice President Medical Compliance Mutual of Omaha Ins. Co. P.O. Box 1602 Omaho, NE 68101 PHONE: 402-351-3614 EMAIL: CHARLES.HAGEN@MUTUALOFOMAHA.COM |
MUTUAL OF OMAHA FIELD OFFICES
DENVER, CO
Rick Keegan Field Audit Manager Panorama Corporate Center V 9200 E Panorama Circle Suite 225 Englewood, CO 80112-3481 PHONE: 303-925-0065 FAX: 303-925-0969 EMAIL: RICK.KEEGAN@MUTUALOFOMAHA.COM |
�� |
SACRAMENTO, CA
Dan Dahl Field Audit Manager Capital Professional Center 2200 B Douglas Blvd. Suite 275 Roseville, CA 95661 PHONE: 916-774-9275 FAX: 916-774-1112 EMAIL: DAN.DAHL@MUTUALOFOMAHA.COM |
�� |
LOS ANGELES, CA
Richard N. Eclarin Field Audit Manager 901 Corporate Center Drive Suite 405 Monterey Park, CA 91754 PHONE: 323-881-9586 FAX: 323-881-9534 EMAIL: RICK.ECLARIN@MUTUALOFOMAHA.COM |
�� |
DALLAS, TX
George Pietri Field Audit Manager 14200 Midway Road Suite 125 Dallas, TX 75244 PHONE: 972-386-4061 FAX: 972-233-9406 EMAIL: GEORGE.PIETRI@MUTUALOFOMAHA.COM |
�� |
KANSAS CITY,MO
Marilyn Huskamp Field Audit Manager 10220 North Executive Hills Blvd. Suite 220 Kansas City, MO 64153 PHONE: 816-891-6500 FAX: 816-891-8817 EMAIL: MARYLIN.HUSKAMP@MUTUALOFOMAHA.COM |
�� |
ST. LOUIS, MO
Mike Connelly Field Audit Manager 11701 Borman Drive Suite 220 St. Louis, MO 63146-4193 PHONE: 314-997-6626 FAX: 314-997-6997 EMAIL: MIKE.CONNELLY@MUTUALOFOMAHA.COM |
�� |
CLEARWATER, FL
Cynthia MacDonald, CPA Field Audit Manager 33920 U.S. Highway 19 North, Suite 360 Palm Harbor, FL 34684 PHONE: 727-772-2557 FAX: 727-772-7193 EMAIL: CYNTHIA.MACDONALD@MUTUALOFOMAH.COM |
ATLANTA, GA
Linda Smallwood Field Audit Manager 2400 Herodian Way Suite 300 Smyrna, GA 30080 PHONE: 770-988-9052 FAX: 770-988-9065 EMAIL: LINDASMALLWOOD@MUTUALOFOMAHA.COM |
�� |
CHICAGO, IL
Art Garvida Field Audit Manager 377 East Butterfield Road Suite 260 Lombard, IL 60148 PHONE: 630-810-1324 FAX: 630-810-1368 EMAIL: ART.GARVIDA@MUTUALOFOMAHA.COM |
�� |
HARFORD, CT
James Zanavich Field Audit Manager 655 Winding Brook Dr. Glastonbury, CT 06033 PHONE: 860-659-4300 FAX: 860-659-8065 EMAIL: JAMES.ZANAVICH@MUTUALOFOMAHA.COM |
402 Otterson Drive
Chico, CA 95928
PHONE: 530-634-7000
FAX: 530-896-7182
INTERNET: www.medicarenhic.com
PART B - CONTRACT NO. HCFA-96-331-2
PART B JURISDICTION: States of California, Massachusetts, Maine, Vermont and New Hampshire (claims processing)
CALIFORNIA (Northern)
Beneficiary Services - 800-952-8627
Provider Services - 877-591-1587
(All counties except San Luis Obispo, Santa Barbara, Ventura, Los Angeles, Orange, San Diego and Imperial)
CALIFORNIA (Southern)
Beneficiary Services - 800-675-2266
Provider Services - 866-502-9054
(For the counties of San Luis Obispo, Santa Barbara, Ventura, Los Angeles, Orange, San Diego and Imperial)
MAINE
Beneficiary Services - 800-492-0919
Provider Services - 877-567-3129
MASSACHUSETTS
Beneficiary Services - 800-882-1228
Provider Services - 877-567-3130
Beneficiary Services - 800-447-1142
Provider Services - 866-539-5595
Senior Vice President
NHIC A6N-B29 13600 EDS Drive Herndon, VA 20171 PHONE: (703) 742-2400 FAX: (703) 742-2871 |
Donald S. Picard
Vice President, Medicare Mailstop A5N-C47 13600 EDS Drive Herdon, VA 20171 PHONE: 703-742-2280 FAX: 703-742-2886 |
�� | |
�� | |
Anne Bockhoff Dalton
Vice President, NHIC Medicare 75 Sgt. William Terry Drive Hingham, MA 02043 PHONE: 781-741-3201 FAX: 781-741-3211 |
Colleen Cerullo
Administrative Assistant NHIC 75 Sgt. William Terry Drive Hingham, MA 02043 PHONE: 781-741-3136 FAX: 781-741-3211 |
�� | |
Paul Ackerman
Director of Southern California Service Operations NHIC-B311 1055 West 7th Street Los Angeles, CA 90017 PHONE: 213-593-6192 FAX: 213-595-5900 |
Andrew Conn
Director of Claims Operations and Northern California Service Operations NHIC 75 Sgt. William Terry Drive Hingham, MA 02043 PHONE: 781-741-3029 FAX: 781-741-3032 |
�� | |
Robert Harrington
Director of New England Customer Service NHIC 75 Sgt. William Terry Drive Hingham, MA 02043 PHONE: 781-741-3255 FAX: 781-741-3083 |
Jane Hite
Director of Business Support NHIC 75 Sgt. William Terry Drive Hingham, MA 02043 PHONE: 781-741-3401 FAX: 781-741-3211 |
�� | |
�� | |
Trace Woodward
Director of Finance 402 Otterson Drive Chico, CA 95928 PHONE: 530-896-7108 FAX: 530-896-7182 |
NATIONWIDE MUTUAL INSURANCE COMPANY - see Blue Cross and Blue Shield of South Carolina
WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION
PART B - CONTRACT NO. HCFA 87-032-2
PART B JURISDICTION: State of Wisconsin, Illinois, Michigan, and Minnesota
ADMINISTRATION
P.O. Box 8190 Madison, Wisconsin 53713 |
STREET ADDRESS
1717 W. Broadway Madison, Wisconsin 53713 |
�� | |
PHONE: 608-221-4711
FAX: 608-301-2625 Madison, Wisconsin 53713 |
|
�� | |
EXECUTIVE
|
|
�� | |
James R. Riordan
President & CEO |
William Bathke
Executive Vice President and COO |
�� | |
Ned Boston
Vice President Medicare Division PHONE: 608-301-2603 |
Mary Strope
Director, Customer Service and Outreach PHONE: 608-301-2605 |
�� | |
David Horst
Director, Operations PHONE: 608-301-2608 |
Lisa Sunde
Director, Training & Quality Improvement PHONE: 608-301-2607 |
�� | |
Sheila Bechmann
Director, Systems PHONE: 608-301-2618 |
Marie Wybo
Director, Detroit Admin. PHONE: 248-395-7701 |
�� | |
Susan Porter
Director, Program Compliance PHONE: 608-221-7582 |
|
�� | |
Wisconsin Claims
P.O. Box 1787 Madison, WI 53701 PHONE: 1-800-MEDICARE (Bene.) |
Illinois Claims
P.O. Box 1030 Marion, IL 62959 PHONE: 1-800-MEDICARE (Bene.) |
�� | |
Michigan Claims
P.O. Box 5555 Marion, IL 62959 PHONE: 1-800-MEDICARE (Bene.) |
Minnesota Claims
8120 Penn Avenue South Bloomington, MN 55431 PHONE: 1-800-MEDICARE (Bene.) |
SECTION IV
REGIONAL HOME HEALTH INTERMEDIARIES
DURABLE MEDICAL EQUIPMENT REGIONAL CARRIERS
COMMON WORKING FILE HOST CONTRACTORS
Regional Home Health Intermediaries
Region I(*)
Anthem Health Plans of Maine, Inc. (d.b.a. Associated Hospital
Service)
2 Gannett Drive
South Portland, Maine 04106-6911
Phone: 207-822-7000
Serving: Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Island, and Vermont
Region IV(*)
Blue Cross and Blue Shield of South Carolina
I-20 at Alpine Road
Columbia, South Carolina 29219
Phone: 803-788-3860
Serving: Kentucky, North Carolina, South Carolina, Tennessee,
Alabama, Florida, Georgia, Mississippi, Arkansas, Louisiana, New
Mexico, Oklahoma, Texas, Illinois, Indiana, and Ohio
Region V(*)
United Government Services, LLC
P.O. Box 9150
Oxnard, CA 93031
Phone: 805-367-0731
Serving: Alaska, Arizona, California, Hawaii, Idaho, Oregon, Nevada,
Washington, Northern Mariana Islands, Guam, and American Samoa
401 West Michigan Street
Milwaukee, Wisconsin 53203-2804
Phone: 414-226-6203
Serving: Michigan, Minnesota, New Jersey, New York, Puerto Rico, the
Virgin Islands, and Wisconsin
Region VII(*)
Blue Cross and Blue Shield of Alabama
P.O. 830139
Birmingham, Alabama 35283-0139
Phone: 205-988-2100
Serving: Colorado, Iowa, Kansas, Missouri, Montana, Nebraska, North
Dakota, South Dakota, Utah, Wyoming, Delaware, District of Columbia,
Maryland, Pennsylvania, Virginia, and West Virginia
*Designates the HCFA Region in which the intermediary is physically located.
Durable Medical Equipment Regional Carriers
Region A
HealthNow New York, Inc.
Donna Cupina
Sr. Director
60 E Main Street
Naticoke, PA 18634
Phone: 570-735-9501
FAX: 570-735-9439
Serving: Connecticut, Delaware, Maine, Massachusetts, New Hampshire,
New Jersey, New York, Pennsylvania, Rhode Island, Vermont
Region B
Michael McCarron
President
AdminaStar Federal Inc.
8115 Knue Road
Indianapolis, Indiana 46250
Phone: 317-841-4510
FAX: 317-841-4691
Serving: District of Columbia, Illinois, Indiana, Maryland, Michigan,
Minnesota, Ohio, Virginia, West Virginia, Wisconsin
Region C
Mr. William R. Horton
Group Vice President
Blue Cross and Blue Shield of South Carolina
I-20 at Alpine Road
Columbus, South Carolina 29219
Phone: 803-735-1034
FAX: 803-786-4636
Serving: Alabama, Arkansas, Colorado, Florida, Georgia, Kentucky,
Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto
Rico, South Carolina, Tennessee, Texas, Virgin Islands
Region D
Mr. Edward Burrell
Vice President
Connecticut General Life Insurance Company
2 Vantage Way
Metro Exchange Building
Nashville, Tennessee 37228
Phone: 615-782-4511
FAX: 615-244-6242
Serving: Alaska, Arizona, California, Guam, Hawaii, Idaho, Iowa,
Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon,
South Dakota, Utah, Washington, Wyoming, American Samoa and Northern
Mariana Islands
Common Working File Host Contractors
Blue Shield of Alabama
Blue Shield of Florida
TrailBlazer Health Enterprise, LLC
SECTION IV - RURAL HEALTH CLINICS
CONTRACTOR | JURISDICTION |
---|---|
Anthem Health Plans of Maine, Inc | Maine |
� � | |
Anthem Health Plans of New Hampshire, Inc. | New Hampshire, Vermont |
�� | |
Highmark Inc. | Connecticut, Delaware, District of Columbia, New York, Pennsylvania, Puerto Rico, Rhode Island, Massachusetts, Virginia, West Virgina, Maryland, New Jersey, Virgin Islands |
� � | |
TrailBlazer HealthEnterprises, LLC | Colorado, Montana, North Dakota, Oklahoma, South Dakota, Utah, Wyoming, Texas, Arkansas, Louisiana, New Mexico |
�� | |
Blue Cross and Blue Shield of Tennessee | Kentucky, Tennessee, North Carolina, South Carolina, Mississippi, Alabama, Georgia, Florida, Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Nevada, Ohio, Oregon, Washington, Wisconsin |