Transition to New Medicare Case Review Contractor

LeadingAge NY has been hearing from members regarding problems associated with the transition from IPRO to Livanta as the new Medicare case review contractor for expedited reviews/generic notices.  For additional information on the transition (including the initial Livanta letter announcing the transition) that was effective as of Aug. 1, 2014, please click here.  In response to member concerns, we have reached out to both Livanta and the Centers for Medicare and Medicaid Services (CMS).

Livanta has acknowledged that there have been issues and they have provided us with assurance that the problems are being resolved.  One issue is that their website did not allow for all providers to complete the Memorandum of Agreement (MOA) by the original Aug. 1 deadline.  In response, Livanta is extending the MOA deadline to Aug. 31, 2014 and is agreeing to process case reviews during this period even if the provider has not completed the MOA.  For member convenience, a copy of the Livanta MOA and a corresponding FAQ are posted on our website.

The majority of concerns raised by members fall into two general categories:

1. The case reviews are not being completed within the required timeframes; and
2. Telephone wait times for both providers and beneficiaries/families are excessive.

Livanta has stated that both these issues are in the process of being resolved.  Livanta should be adhering to the same case review processing times as IPRO.  In instances where they have not been able to comply with the required processing times, they have been granted permission from CMS to make an exception such that neither the provider nor the beneficiary is penalized.  Livanta has also stated that they have the necessary staff in place to process reviews during weekends and off hours.

They have also assured us that they have reorganized and added call service personnel and that both providers and beneficiaries/families should be experiencing more reasonable call wait times.

Any transition of this nature is likely to be fraught with some problems.  LeadingAge NY is grateful to members for alerting us to their concerns.  Please let us know if you continue to experience difficulties so that we may take steps to help correct any issues.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827