Healthcare Integrated General Ledger Accounting System (HIGLAS) - JA DME
Healthcare Integrated General Ledger Accounting System (HIGLAS)
Introduction to HIGLAS
Healthcare Integrated General Ledger Accounting System (HIGLAS) a financial accounting system will enable the Centers for Medicare & Medicaid Services (CMS) to track Medicare payments and to accurately pay claims for over 40 million Medicare beneficiaries. The transition will also provide CMS with enhanced oversight of contractors' accounting systems, as well as access to more accurate, timely and consistent data for decision-making and for performance evaluations.
On this page, view the below information.
- Transition Dates
- Restoring Payment Floor
- Remittance Advice (RA) Change
- Claim Payments Less than $1.00
- Claims and Refund Payments Subject to a Hold, e.g., Do Not Forward (DNF), Bankruptcy and Payment Suspension
- Claims and Refund Payments Subject to Third Party Payer (TPP) Offset, e.g., IRS Backup Withholding
- Payment Withholdings for Affiliated Providers
- HIGLAS Impact on Claims Processing
- Contact Us
Effective March 16, 2020, Noridian DME MAC Jurisdiction A will be transitioning our financial accounting system from the DME Shared System (Vips Medicare System (VMS)) to HIGLAS. This transition involves only our financial accounting system. We will continue to use VMS for all our claims processing activities.
On March 11, 2020, Noridian Jurisdiction A will run our last VMS payment cycle and begin the HIGLAS transition.
Waiver of the payment floor will result in some claim payments (checks and EFTs) being issued earlier than normal.
- Providers are encouraged to continue submitting claims as normal.
- Following our transition to HIGLAS, Jurisdiction A will resume normal cycles on March 16, 2020, at which time providers will also be able to retrieve their Electronic Remittance Advices (ERA).
- Payments will not be issued on March 12, or March 13, 2020, and providers may experience a gap in payment activity with some claims having already been paid early due to the waiver of the payment floor. Providers should plan accordingly.
Restoring Payment Floor
The payment floor will be restored in HIGLAS post transition. Claims received as of March 11, 2020, will include the payment floor processing so suppliers will receive Medicare payment for claims submitted as of these dates based on the applicable payment floor (15 days for EMC and 28 days for paper).
Remittance Advice (RA) Change
ERAs and paper RAs will not be available during the transition. Distribution of RAs will resume the week of March 16, 2020. The RA will display the Jurisdiction A two-digit plan code "JA" in front of the claim Internal Control Number (ICN) as shown below.
(ICN Example: JA20000180012000)
Claim Payments Less than $1.00
Current CMS instructions require carriers to hold claim payments of less than $1.00 until another payment greater than $1.00 is generated and then to combine the two payments. Payments less than $1.00 will now be issued because HIGLAS functionality at this time will not suppress these payments.
Claims and Refund Payments Subject to a Hold, e.g., Do Not Forward (DNF), Bankruptcy and Payment Suspension
Providers may be placed on a hold due to a forwarding address, bankruptcy and payment suspension. In HIGLAS, the holds will be applied at the claim level. Similar to the current system, holds will be applied before any overpayment netting has occurred. As a result, the held money will not be applied to eligible receivables until the hold has been released.
Claims and Refund Payments Subject to Third Party Payer (TPP) Offset, e.g., IRS Backup Withholding
A provider payment may be subject to offsetting to a third party, such as the IRS. In the current environment, when a provider is subject to TPP, a provider check is pulled, the payment is remitted to the third party, but no notification is provided on the RA. HIGLAS will communicate a TPP offset of a provider's payment on the provider's RA.
Payment Withholdings for Affiliated Providers
In HIGLAS when two or more providers are affiliated and have the same Tax Identification Number (TIN), payments may be withheld from one provider to collect another provider's overpayments. Overpayment collections from affiliated providers shall begin once HIGLAS is implemented. If you believe the TIN associated with your provider number is incorrect, please contact the National Provider Enrollment (NPE) at 1-866-520-5193 for assistance.
HIGLAS Impact on Claims Processing
Our online system is available on Federal holidays and Jurisdiction A processes claims on some Federal holidays. There will be no change to provider payments because Jurisdiction A does not issue checks or EFTs on Federal holidays.
Suppliers may email Noridian [complete/submit Contact Us Form] general Medicare inquiries regarding regulations and coverage. Note: Allow up to 45 business days to receive a response on postal and/or email submitted inquiries.
For a quicker inquiry response, contact our Supplier Contact Center to speak directly with a Customer Service Representative.
Do not email us Confidential information as it is possible for others to view the email contents, exposing you or others as a target for fraud or abuse. This includes private information such as patient names, claim information, Medicare IDs, Social Security Numbers (SSNs), Claim Control Numbers (CCNs) or provider numbers. If you have a question that contains confidential information, contact our Supplier Contact Center.
Note: Allow up to 45 business days to receive a response on postal and/or email submitted inquiries.
Last Updated Wed, 09 Nov 2022 14:47:54 +0000