Simply click on your state where you’ll find a link to all relevant MACs. For example, if you live in Rhode Island, your Medicare Part A/B MAC is National Government Services, Inc., the MAC for jurisdiction K. This MAC also assists with home health and hospice claims.
Full Answer
What is a MAC in Medicare?
MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims. MACs perform many activities including: Section 911 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003 directed CMS to replace the Part A Fiscal Intermediaries (FIs) and Part B carriers with MACs.
Are there any resources for Medicare administrative contractors (Macs)?
If you are a Medicare Administrative Contractor (MAC), here are some helpful resources. If you aren’t a MAC, you still might find these resources helpful to understand what MACs do and how they do it. Federal Acquisition Regulation (FAR): CMS follows the requirements of the FAR in procuring and managing the MAC contracts.
How many Medicare claims do Macs process each year?
Collectively in FY2020, the MACs processed more than 1.1 billion Medicare FFS claims, comprised of approximately 203 million Part A claims and 909 million Part B claims, and paid out approximately $400 billion in Medicare FFS benefits.
How do I look up a Medicare patient’s MBI?
Using your MAC’s portal, you can look up any Medicare patient’s MBI, regardless of where the patient lives. If you previously saw a patient and got a claim payment decision based on a claim submission with a HICN before January 1, 2020, look at that remittance advice.
What is my Medicare Mac?
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.
Who is my Medicare carrier?
You can find the name of your plan provider on your Medicare plan Member ID card (for instance, you may read: Humana, Aetna, WellCare, Cigna, or United Healthcare/AARP).
Who is my Medicare fiscal intermediary?
Medicare Part B Services. Medicare Administrative Contractors (MACs) regionally manage policy and payment related to reimbursement and act as the fiscal intermediary for Medicare.
Who is the Medicare MAC for Michigan?
WPS Health SolutionsWPS Health Solutions (WPS) has been the Medicare Administrative Contractor (MAC) for Jurisdiction 5, which includes Parts A/B for the states of Iowa, Kansas, Missouri, and Nebraska, since September 2007, J5 National since October 2012, and Jurisdiction 8, which includes Parts A/B for the states of Indiana and Michigan, ...
What is the MAC locality?
However, the Medicare Administrative Contractors (MACs) have been allowed to process claims using what we refer to as the “locality rule”. The “locality rule” allows for when patients normally seek medical attention at a few regional hospitals on a regular basis.
What is a DME MAC?
A Durable Medical Equipment Medicare Administrative Contractor (DME MAC) is a private insurance company that has a contract with Medicare to process durable medical equipment (DME) claims.
Who is the Mac for Missouri?
The Missouri Association of Counties (MAC), formed in 1972, is a nonprofit, nonpartisan member service organization dedicated to the improvement of county government.
Who is the Medicare MAC for Minnesota?
NGS will administer all of the Medicare Part A and Part B claims for Medicare covered services in Minnesota, Illinois and Wisconsin. NGS will also replace Wisconsin Physicians Service (WPS) which has served as the Part B Medicare carrier for MN since 2000.
What is a fiscal intermediary carrier?
What Is a Fiscal Intermediary/Medicare Administrative Contractor? by David Levine | Published March 22, 2021 | Reviewed by John Krahnert. A fiscal intermediary (FI) is a privately held company that serves as an intermediary between two parties that are trying to work together to resolve conflicts.
How many MACs are there for the DME?
FourHow 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.
What Medicare region is Michigan in?
Jurisdiction B is serviced by CGS and includes Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin.
Which has been replaced with Medicare administrative contractors?
In 2003 the Centers for Medicare & Medicaid Services (CMS) was directed via Section 911 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003 to replace the Part A FIs and Part B carriers with A/B Medicare Administrative Contractors (MACs) in accordance with the Federal Acquisition ...
What is MAC in Medicare?
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. CMS relies on a network of MACs to serve as the primary operational contact ...
How many A/B MACs are there?
There are four A/B MACs that process home health and hospice claims in addition to their typical Medicare Part A and Part B claims. Please note that the four HH+H areas do not coincide with the jurisdictional areas covered by these four A/B MACs. Learn more about HH+H areas and the MACs responsible for them at Who are the MACs.
What is MAC in Medicare?
Your Medicare Administrative Contractor (MAC) not only processes your Medicare claims, it also determines coverage for certain items and services you might need. Learn more about the role your specific MAC plays.
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.
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.
How many MACs does Medicare use?
In total, Medicare uses four MACs to process requests and payments for durable medical equipment. Vitally important, durable medical equipment provides part of treatment around the clock such as an oxygen tank or wheelchair.
What is the Hub of Medicare?
Carriers are the Hub of Original Medicare. Amazingly, in 2020 alone Part A and Part B carriers processed more than $400 billion in claims, bills, disputes, and appeals for the Medicare Fee-For-Service program. As well as handling the ins-and-outs of medical claims, Medicare Administrative Carriers educate providers to develop improvements ...
What is Medicare carrier?
Medicare uses private carriers for business functions, durable medical equipment, processing insurance claims and reviewing appeals. Basically, Medicare employs different Part A and B administrative carriers for various regions of the country. Likewise, other private insurance companies manage claims, and reimbursements for Medicare Advantage, ...
How many Medicare administrative contractors are there?
When a claim occurs, Medicare requests the member to send the claim to the carrier responsible for the area in which the claim occurred. Currently, there are 12 Medicare Administrative Contractors that serve the nation, four of which process home healthcare and hospice claims.
How many MACs will be in 2020?
In 2020 alone, the MACs served over 1.1 million health care providers who participate with the Medicare program.
What is private Medicare?
Predominantly, the private Medicare health plans are the prescription drug coverage in Part D, Part C Medicare Advantage and the gap insurance of Medicare Supplement. Part A is Hospital Insurance.
What is Medicare insurance?
Basically, Medicare is the national program for comprehensive hospital and medical insurance for older or disabled Americans.
