What is a Medicare administrative contractor?
A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.
What is an administrative contractor?
Administrative Contractors means the persons or entities engaged by the Administrators, if any, and to whom the Administrators may delegate duties assigned to the Administrators under this Agreement, including, without limitation, duties associated with provision of Notice, calculation of Claims, and preparation and ...
What is Medicare jurisdiction?
United StatesCenters for Medicare & Medicaid Services / Jurisdiction
Who is the Medicare Administrative Contractor for Missouri?
WPS GHA currently serves: Medicare Administrative Contractor (MAC) Jurisdiction 5 (J5) - providing both Part A and Part B Medicare benefit administration for Iowa, Kansas, Missouri, and Nebraska, as well as Part A Medicare benefit administration for J5 National providers.
Who is the Medicare administrative contractor for California?
Noridian Healthcare SolutionsNoridian Healthcare Solutions is the Medicare Administrative Contractor for California and is responsible for processing all Medicare fee-for-service Part A and B claims.
Who is the Medicare administrative contractor for Maryland?
Contract Implementation Status and Schedule * As Novitas Solutions, Inc. is the incumbent contractor for this A/B MAC jurisdiction, CMS anticipates that implementation of the new contract will go smoothly, with few (if any) disruptions in service for Medicare beneficiaries and providers.
How many jurisdictions are there in Medicare?
Centers for Medicare and Medicaid Services (CMS) announced in 2010 plans to reduce the number of A/B Medicare Administrative Contractors (MACs) from the current numbered 15 jurisdictions to 10 alphabetical jurisdictions over the next several years.
Where is Medicare Jurisdiction A?
United StatesCenters for Medicare & Medicaid Services / Jurisdiction
Who is the Medicare Administrative Contractor for Massachusetts?
* As National Government Services, Inc. (NGS) is the incumbent contractor for A/B MAC Jurisdiction K, CMS anticipates that implementation of the new contract will go smoothly, with few (if any) disruptions in service for Medicare beneficiaries and providers.
Who is the Medicare contractor for New York?
National Government Services (NGS) administers Medicare health insurance for the Centers for Medicare & Medicaid Services (CMS) for Jurisdiction K which includes the State of New York.
Who is the Medicare contractor for Florida?
First Coast Services Options, Inc.In the State of Florida, there is only one choice for your Medicare Administrative Contractor (MAC) - First Coast Services Options, Inc., P.O. Box 45169, Jacksonville, FL 32202.
Who is the Medicare administrative contractor for Wisconsin?
Guidance for CMS' announcement on September 5, 2007, that Wisconsin Physicians Service Health Insurance Corporation (WPS) has been awarded the contract for the combined administration of Part A and Part B Medicare fee-for-service claims in Jurisdiction 5 (J5).
How much is the Medicare contract?
The contracts, which have an approximate value of $1.4 billion over five years, will fulfill the requirements of the Medicare Modernization Act’s (MMA) contracting reform provisions.
What states does Highmark accept hospice claims?
Highmark will also process home health and hospice claims from providers in the states of Colorado, Delaware, District of Columbia, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia and Wyoming.
What is MAC contract?
The MAC contracts are another step toward improved service to providers, physicians and practitioners as well as greater administrative efficiency and effectiveness for fee-for-service Medicare.
What Is a MAC?
Think of a MAC as a middleperson between you, your doctor and the Centers for Medicare & Medicaid Services (CMS). Each geographic region (also known as jurisdiction) has a specific MAC that handles the payment side of the Medicare fee-for-service program. MACs are also charged with conducting audits and educating providers.
How Many Macs Exist?
Currently, there are 12 Medicare Part A and B MACs that assist with Original Medicare (Medicare Parts A and B). Four of these MACs also process home health and hospice claims in addition to their typical Medicare Part A and Part B claims. There are also four durable medical equipment (DME) MACs.
Why Are MACs Important?
MACs are important because they ensure your doctor gets paid correctly. They also create what’s called local coverage determinations (LCD) based on whether an item or service is considered reasonable and necessary. LCDs exist in the absence of a national coverage policy, and they may vary from jurisdiction to jurisdiction.
When Would I Need to Find a Specific LCD?
You might need to find an LCD if you’re filing an LCD challenge. You can do this if you have Medicare Part A, Medicare Part B (or both), and you need the item or service that’s not covered by the LCD. However, you need to file your request within six months of the date of the treating doctor’s written statement that you need the item or service.