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.
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.
What states are covered by Mac a and B?
MAC Jurisdiction Processes Part A & Part B Claims for the following states: MAC DME A Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont Noridian Healthcare Solutions, LLC
How many Macs are in the Medicare FFS program?
Currently there are 12 A/B MACs and 4 DME MACs in the program that process Medicare FFS claims for nearly 60% of the total Medicare beneficiary population, or 37.5 million Medicare FFS beneficiaries. In Fiscal Year 2020 (FY2020), the MACs served more than 1.1 million health care providers who are enrolled in the Medicare FFS program.
Who is the Medicare MAC for Colorado?
CGS takes care of Jurisdiction DME B and DME C which covers: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico, U.S. Virgin Islands, Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, ...
What is my Medicare Mac?
What's a MAC and what do they do? 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.
Which Medicare jurisdiction is Colorado?
Jurisdiction CJurisdiction C is serviced by CGS and includes Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, West Virginia and the US Virgin Islands.
Is novitas a Mac?
As the Medicare Administrative Contractor (MAC), Novitas will continue to perform administrative services processing and pay claims for both Parts A and B of the Medicare program. Novitas also holds the MAC JH contract which serves Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas.
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 is the difference between RAC and MAC?
MAC audits are powerful and intrusive procedures that have the potential to lead to serious federal charges for healthcare entities. A Recovery Audit Contractor (“RAC”) reviews claims and identifies overpayments from Medicare so that CMS and other auditors are able to prevent improper payments in the future.
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.
What states are in Medicare jurisdiction D?
DME MAC Jurisdiction D – DME Facts JD processes FFS Medicare DME claims for Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming.
What states are in Medicare Region A?
DME MAC Jurisdiction A - DME FactsJA processes FFS Medicare DME claims for Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.Total Number of Fee-for-Service Beneficiaries: 7,649,029 (as of 9/30/2021)More items...•
What is Medicare novitas?
It is private health insurance designed specifically to supplement Medicare benefits by filling in some of the gaps in Medicare coverage. Examples of some of the gaps in Medicare coverage are: Deductible - The amount a beneficiary pays for Medicare approved expenses before Medicare starts to pay.
Who owns novitas solutions?
Diversified Service Options, Inc.Novitas Solutions, Inc. is a wholly owned subsidiary of Diversified Service Options, Inc., doing business as GuideWell Source, a subsidiary of GuideWell Mutual Holding Corporation.
What states does novitas cover?
Contact DetailsOrganization Type:A/B MAC -- A/B Medicare Administrative ContractorRegions:Region Three - PhiladelphiaCovered States and Territories:Arkansas, Colorado, Louisiana, Mississippi, Oklahoma, Texas, New MexicoAddress:2020 Technology Parkway Suite 100 Mechanicsburg PA 170503 more rows
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.
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?
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 ...
Who are the Medicare Administrative Contractors (MAC)?
A Medicare Administrative Contractors or MAC for short is a private health insurer who has been granted certain geographical jurisdictions in the USA by CMS 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 Novitas Solutions?
Novitas Solutions provides high-quality, innovative, administrative services for government-sponsored healthcare programs and serves as a Part A/B Medicare Administrative Contractor (MAC) under multiple contracts for the Centers for Medicare and Medicaid Services (CMS). Novitas was founded in 1965 (kind of a running them for MAC's if you have been paying attention)
What is the most important event for all of us?
However, for us, the most important event for all of us was President Lyndon B Johnson signing of the H.R. 6675 legislation for what we know as Medicare, which would allow Americans to start receiving Medicare health coverage when Medicare’s hospital and medical insurance benefits. Fun Fact: President Lyndon B Johnson would be ...
What states does Palmetto GBA cover?
Palmetto GBA handles jurisdiction M and J which covers North Carolina, South Carolina, Virginia, West Virginia (excludes Part B for the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia) Alabama, Georgia, Tennessee.
How many people will be enrolled in Medicare by 2030?
Fun Fact: Currently there are 44 Million beneficiaries enrolled in Medicare, and it is estimated that nearly 80 million beneficiaries will be enrolled in Medicare by 2030. Ok, everyone back in the time machine we are heading to 2003 and talking about Medicare Administrative Contractors (MAC).
Where is Noridian Healthcare located?
They have been twice awarded the Medicare and Medicaid customer service program of the year award. Their headquarters can be located in Fargo, ND .
When was Novitas founded?
Novitas was founded in 1965 (kind of a running them for MAC's if you have been paying attention) Novitas currently handles Jurisdiction H which includes: Arkansas, Colorado, New Mexico, Oklahoma, Texas, Louisiana, Mississippi. First Coast Service Options First Coast Service Options was founded in you guessed it 1965.
What is Medicaid eligibility based on?
Most Medicaid eligibility and all CHIP eligibility is based on modified adjusted gross income (MAGI). Income eligibility levels are tied to the federal poverty level (FPL).
How many people are in Medicaid in 2019?
As of December 2019, has enrolled 985,201 individuals in Medicaid and CHIP — a net increase of 57.29% since the first Marketplace Open Enrollment Period and related Medicaid program changes in October 2013. has adopted one or more of the targeted enrollment strategies outlined in guidance CMS issued on May 17, 2013, designed to facilitate enrollment in Medicaid and CHIP.
What is the source of information for Medicaid?
Medicaid and CHIP agencies now rely primarily on information available through data sources (for example, the Social Security Administration, the Departments of Homeland Security and Labor) rather than paper documentation from families for purposes of verifying eligibility for Medicaid and CHIP.
How many quality measures are there in 2019?
In federal fiscal year (FFY) 2019, reported of 24 frequently reported health care quality measures in the CMS Medicaid Adult Core Set. These counts do not include the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan Survey 5.0H, Adult Version (Medicaid) (CPA-AD) measure, which is publicly reported by CMS but uses a different summary statistic. When a state did not report a measure or used non-Core Set specifications, the measure is not included below or in the count of measures reported by the state.
Does the CHIP cover pregnant women?
4. States have the option to cover pregnant women under CHIP. This table does not include notations of states that have elected to provide CHIP coverage of unborn children from conception to birth.
