TriCenturion is a Program Safeguard Contractor (PSC) under contract with the Centers for Medicare & Medicaid Services (CMS) to perform selected Medicare program integrity functions. Currently, TriCenturion is working on the following contracts:
TriCenturion performs all Medicare Program Integrity functions for DME Region A/B. These functions include medical policy development, fraud investigations, prepay and post-pay medical review of claims, and data analysis. In this contract, TriCenturion works closely with the Affiliated Contractors(AC) National Heritage Insurance Company for Region A and National Government Services for Region B. They continue to perform program management functions for the regions. To support this work TriCenturion has offices in Columbia, SC. TriCenturion began the Region A workload in this contract on May 1, 2001 and added the Region B workload on March 1, 2006.
PSC for Medicare Part A Workload for Colorado, New Mexico, and Texas; Part B Workload for Delaware, Maryland, Texas, Virginia, and Metro D.C.
Under this task order, awarded on June 3, 2002, TriCenturion performs fraud and abuse safeguard functions for the Part A workload jurisdictions of Colorado, New Mexico, and Texas and the Part B workload jurisdictions of Texas, Virginia, Maryland, Delaware, and the District of Columbia. TriCenturion's functions include fraud case development, national and regional data analysis, law enforcement support, medical review to support fraud and abuse cases, fraud prevention education, fraud complaint processing, and other support functions. To support this work TriCenturion has offices in Dallas, TX, Timonium, MD, and Columbia, SC. The PSC fraud and abuse workload transitioned to TriCenturion on October 1, 2002. TrailBlazer Health Enterprises, LLC (the Affiliated Contractor) remains responsible for all program management functions, medical review, medical policy development, and audit/reimbursement.
PSC for Part A and B for SC; and RHHI for Kentucky, North Carolina, South Carolina, Tennessee, Alabama, Florida, Georgia, Mississippi, Arkansas, Louisiana, New Mexico, Oklahoma, Texas, Illinois, Indiana, and Ohio
Under this task order, effective January 15, 2003, TriCenturion performs fraud and abuse safeguard functions for Medicare Part A and B in South Carolina and for the Regional Home Health Intermediary states of Kentucky, North Carolina, South Carolina, Tennessee, Alabama, Florida, Georgia, Mississippi, Arkansas, Louisiana, New Mexico, Oklahoma, Texas, Illinois, Indiana, and Ohio. TriCenturion's functions include fraud case development, national and regional data analysis, law enforcement support, medical review to support fraud and abuse cases, fraud prevention education, fraud complaint processing, and other support functions. To support this work TriCenturion has offices in Columbia, SC, Clearwater, FL, Dallas, TX, and Indianapolis, IN. Palmetto Government Benefits Administrators (the Affiliated Contractor) remains responsible for program management functions, medical review, medical policy development, and audit/reimbursement.
PSC for ESRD Audits
Under this Task Order, awarded on September 26, 2003, TriCenturion performs audits of End Stage Renal Disease (ESRD) facilities located throughout the United States. In the contract, TriCenturion works closely with the Affiliated Contractor (AC), Blue Cross Blue Shield of Georgia, which continues to perform all other program management functions for the workload.
The responsibilities under the Task Order are to perform audits for a portion of the ESRD facilities who are serviced by the AC, to ensure the Healthcare Cost Report Information System (HCRIS) database maintained by the Centers for Medicare and Medicaid Services contains reliable and accurate ESRD facility cost report data, to comply with Section 4558 of the Balanced Budget Act of 1997 and to ensure bad debts are claimed properly and recoup any unallowable bad debts claimed by providers.
To support this work, TriCenturion has an audit operations office located in Palm Harbor, Florida.
Medi-Medi PSC for Texas
TriCenturion's workload in Texas has been expanded to add fraud and abuse detection and prevention activities for the Medicaid Program. This additional workload requires performing computerized matching and analysis of Medicare and Medicaid data.