Here’s a rundown on the changes of keenest interest to insurance advisors...
DEPARTment of Health & Human Services
Centers for Medicare & Medicaid Services
200 Independence Avenue, SW
Washington, DC 20201
Office of Media Affairs
MEDICARE FACT SHEET
January 7, 2009
MEDICARE ADMINISTRATIVE CONTRACTOR (MAC) AWARDS
TO FIVE JURISDICTIONS
Background: The Centers for Medicare and Medicaid Services (CMS) today announced the five Medicare Administrative Contractors (MACs) awarded contracts for the combined administration of Part A and Part B Medicare fee-for-service claims. The five MAC jurisdictions cover 14 states and represent approximately 36% of the total fee-for-service claims processed in 2008. 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.
The MACs serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other health care practitioners. The MACs were selected using competitive procedures in accordance with federal procurement rules.
The new contractors will administer and pay claims, tasks currently performed by fiscal intermediaries and carriers. 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.
Under the current system, fiscal intermediaries process claims for Medicare Part A providers, such as hospitals, skilled nursing facilities and other institutional providers. Carriers process claims for physicians, laboratories and other practitioners under Medicare Part B. When fully implemented, Medicare Administrative Contractors will review and process all fee-for-service claims submitted to Medicare for payment. In 2008, Medicare processed more than 1.1 billion fee-for-service claims and paid more than $400 billion in fee-for-service benefits under the original Medicare benefit.
The contracts include a base period and four one-year options and will provide the contractors with an opportunity to earn award fees based on their ability to meet or exceed the performance requirements set by CMS.
The contractors awarded Part A and Part B MAC contracts are:
Noridian Administrative Services, LLC (NAS) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 6 comprised of Illinois, Minnesota and Wisconsin. Noridian will also process home health and hospice claims from home health agencies and hospices in the states of Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Islands, Oregon, Puerto Rico, U.S. Virgin Islands, Wisconsin and Washington. The NAS website is https://www.noridianmedicare.com/.
National Government Services (NGS) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 8 comprised of Indiana and Michigan. The NGS website is http://www.ngsmedicare.com/ngsmedicare/HomePage.aspx.
Cahaba Government Benefit Administrators, LLC (Cahaba GBA) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 10 comprised of Alabama, Georgia and Tennessee. Cahaba GBA's website is https://www.cahabagba.com/.
Palmetto Government Benefits Administrator, LLC (Palmetto GBA) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 11 comprised of North Carolina, South Carolina, Virginia and West Virginia. Palmetto GBA will also process home health and hospice claims from providers in the states of Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and Texas.
Palmetto GBA's website is http://palmettogba.com/palmetto/palmetto.nsf/SiteHome'ReadForm.
Highmark Medicare Services (HMS) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 15 comprised of Kentucky and Ohio. 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. The HMS website is http://www.highmarkmedicareservices.com/.
CMS awarded the first A/B MAC contract in July 2006. The list of all contractors and the states they cover, along with other information, can be found at http://www.cms.hhs.gov/MedicareContractingReform/
# # #