In order to expedite the Wage Index process, we are requesting that all Wage Index data and documentation be sent with the submission of the cost report, utilizing the "Wage Index package" (Exhibit C). This package includes forms and a contact sheet.

Completing the Wage Index package at the time of the cost report submission will enable the provider to support the numbers on Worksheet S-3, Part II and Part III, while the information is currently available.

A contact sheet has been provided to obtain the most current contact information for Wage Index. The forms should always be used as support for the required lines on Worksheet S-3, Part II (specified in the Wage Index package). This will eliminate any confusion as to how and what documentation should be presented.

To obtain Wage Index forms, please click on the Wage Index Package (Exhibit C) on the National Government Services, Inc. Web site at: http://www.empiremedicare.com/A&R/form.htm. Forms may be submitted either by mail or e-mail.

• By mail: Send forms along with the cost reports to:

Tari Robinson
Audit and Reimbursement
National Government Services, Inc.
P.O. Box 4846
Syracuse, NY 13221-4846

• By e-mail: Send forms to: wageindex@empireblue.com. For instructions on how to submit the completed forms via e-mail, please see the E-mail Instructions page located in Exhibit C pdf file.  http://www.empiremedicare.com/A&R/form.htm.

Thank you for your cooperation!

Page Last Modified: 11/01/07