Clearinghouses/Claim Submitters

During this Hospice pilot, the Center for Medicare and Medicaid Services (CMS) asked the clearinghouses and other entities who submit Medicare Hospice election notifications directly to the Medicare Administrative Contractors, to also send a copy of their transactions to the Medicare Part D Transaction Facilitator (RelayHealth).

837I files will be sent by clearinghouses and/or claim submitters to the Medicare Part D Transaction Facilitator. The Medicare Part D Transaction Facilitator will utilize the Notice of Election (NOE) data to:

  • Determine which Medicare Part D sponsor should receive the NOE and send the NOE via an Nx transaction.
  • Determine which hospice providers should receive a report on the status of the NOE and send the report.
  • Report all clearinghouse NOE transactions to CMS for pilot validation purposes.

Clearinghouses Axxess and Waystar are participating in this pilot.

CMS appreciates their participation and support in helping their customers automate the Hospice Election notification.

A high-level summary of the notification process for Hospice