TO: Honorable Mayor & Members of the North Port Commission
FROM: A. Jerome Fletcher II, ICMA-CM, MPA, City Manager
TITLE: Approve the Updating of the Online Portal and Completion of the Medicare Enrollment Application to Reflect Mayor Langdon as the Assigned Authorized Official to Allow for North Port Fire Rescue’s Primary Billing Company, Digitech, to Submit Claims and Receive Remits on North Port Fire Rescue’s Behalf.
Recommended Action
Approve the updating of the online portal and completion of the Medicare Enrollment Application to reflect Mayor Langdon as the assigned Authorized Official to allow for North Port Fire Rescue’s primary billing company, Digitech, to submit claims and receive remits on North Port Fire Rescue’s behalf.
Background Information
This agreement will allow North Port Fire Rescue's primary billing company, Digitech, to submit claims directly to Medicare. The online portal and applications/agreements must be created and updated as new Authorized Officials (AO) are assigned. The Mayor has been identified as the AO for these documents, per the City Attorney’s guidance. These were previously completed by former Mayor Luke and Mayor Emrich.
Medicare Enrollment Application - CMS-855B will require Section 6: Ownership Interest and/or Managing Control Information (Individuals) only be completed by Mayor Langdon in order for Digitech to populate the remainder of the application via an online portal to subsequentially be digitally signed.
The City Attorney’s office has reviewed the document for form and correctness.
Strategic Plan
Safe Community
Financial Impact
Failure to submit this agreement would result in the suspension of the City’s Medicare provider number, resulting in a significant loss of revenue for the General Fund.
Procurement
Not applicable
Attachments:
1. Medicare Enrollment Application - CMS-855
Prepared by: Deanna Marshall, Business Manager
Department Director: Scott Titus, Fire Chief