Who are the administrative contractors for Medicare?
Medicare Administrative Contractors Since Medicare’s inception in 1966, private health care insurers have processed medical claims for Medicare beneficiaries. Originally these entities were known as Part A Fiscal Intermediaries (FI) and Part B carriers.
What does it mean to be a Medicare contractor?
Definition of Contractors. Medicare Administrative Contractor is a contractor that performs Medicare fee-for-service claims administration services that is awarded a contract through competitive procedures in keeping with Section 1874A of the Social Security Act.
What does a medical review contractor do?
Definition of Contractors. The Supplemental Medical Review Contractor is a contractor that performs Medicare medical review activities as directed by CMS. This is a contract that is awarded through competitive procedures in keeping with Section 1874A of the Social Security Act.
What is a supplemental medical review contractor (SMRC)?
The Supplemental Medical Review Contractor is a contractor that performs Medicare medical review activities as directed by CMS. This is a contract that is awarded through competitive procedures in keeping with Section 1874A of the Social Security Act.
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.
How many Medicare contractors are there?
Currently, there are 12 A/B MACs and 4 DME MACs. These MAC's service nearly 1.5 million health care providers enrolled in the Medicare FFS program and process more than 1.2 billion Medicare FFS claims annually. Try wrapping your head around those numbers!
Who is the Medicare Part B carrier for the state of Indiana?
MAC Jurisdiction 8 (J8) - providing both Part A and Part B Medicare benefit administration for Indiana and Michigan. As a subcontractor for other CMS contracts....Region Service was Performed in:Part B Medical ClaimsPart A Facility ClaimsMIB MI (J8)INA IN (J8)MIA MI (J8)2 more rows•Jul 15, 2016
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 ...
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 adjudicates Medicare claims?
Administrative Law Judge (ALJ) – Adjudicator employed by the Department of Health and Human Services (HHS), Office of Medicare Hearings and Appeals (OMHA) that holds hearings and issues decisions related to level 3 of the appeals process.
What Medicare jurisdiction is Illinois?
Jurisdiction 6National Government Services (NGS) administers Medicare health insurance for the Centers for Medicare & Medicaid Services (CMS) for Jurisdiction 6 which includes the State of Illinois.
What are the top 3 Medicare Advantage plans?
The Best Medicare Advantage Provider by State Local plans can be high-quality and reasonably priced. Blue Cross Blue Shield, Humana and United Healthcare earn the highest rankings among the national carriers in many states.
Can I get Medicare Part B for free?
While Medicare Part A – which covers hospital care – is free for most enrollees, Part B – which covers doctor visits, diagnostics, and preventive care – charges participants a premium. Those premiums are a burden for many seniors, but here's how you can pay less for them.
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.
What is Medicare contracting reform?
The fee-for-service contracting reform also integrates Medicare Parts A and B under a single contractor, known as a Medicare administrative contractor (MAC). With this change, providers will have one contractor per designated region that will process both Part A and Part B claims.
What organization handles Medicare claims?
The federal agency that oversees CMS, which administers programs for protecting the health of all Americans, including Medicare, the Marketplace, Medicaid, and the Children's Health Insurance Program (CHIP).
Current Maps and Lists
To find out who the current A/B and DME MACs are, use these maps and lists to help you determine which MAC is of most interest to you.
DME MACs
The DME MACs process Medicare Durable Medical Equipment, Orthotics, and Prosthetics (DMEPOS) claims for a defined geographic area or "jurisdiction," servicing suppliers of DMEPOS. Learn more about the DME MAC in each jurisdiction.
What is a Supplemental Medical Review Contractor?
The Supplemental Medical Review Contractor is a contractor that performs Medicare medical review activities as directed by CMS. This is a contract that is awarded through competitive procedures in keeping with Section 1874A of the Social Security Act. Top.
What is CERT in Medicare?
Comprehensive Error Rate Testing (CERT) program is to measure improper payments in the Medicare fee-for-service (FFS) program. The CERT program cannot be considered a measure of fraud. Since the CERT program uses random samples to select claims, reviewers are often unable to see provider billing patterns that indicate potential fraud when making payment determinations. CERT is designed to comply with the Improper Payments Elimination and Recovery Act of 2010.