Basics Of Medicare Administrative Contractor (MAC)

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Basics Of Medicare Administrative Contractor
(MAC)
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Basics Of Medicare Administrative Contractor (MAC)
Whats a Medicare Administrative Contractor
(MAC)? Its quite common for any provider to get
confused while billing to Medicare for healthcare
services, as they not billing to Medicare but to
a MAC. In this article, we discussed about what
is MAC and activities handled by all these
contractors. To start from basic, 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. Currently
there are 12 A/B MACs and 4 DME MACs in the
program that process Medicare FFS claims for
nearly 56 percent of the total Medicare
beneficiary population, or 36 million Medicare
FFS beneficiaries. CMS relies on a network of
MACs to serve as the primary operational contact
between the Medicare FFS program and the health
care providers enrolled in the program. MACs are
multi-state, regional contractors responsible for
administering both Medicare Part A and Medicare
Part B claims. In Fiscal Year 2021 (FY2021), the
MACs served more than 1.1 million health care
providers who are enrolled in the Medicare FFS
program. Collectively in FY2021, the MACs
processed more than 1.1 billion Medicare FFS
claims, comprised of approximately 221 million
Part A claims and 956 million Part B claims, and
paid out approximately 424 billion in Medicare
FFS benefits.
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Basics Of Medicare Administrative Contractor (MAC)

• Activities done by MACs
• MACs perform many activities including
• Process Medicare FFS claims
• Make and account for Medicare FFS payments
• Enroll providers in the Medicare FFS program
• Handle provider reimbursement services and audit
  institutional provider cost reports
• Handle redetermination requests (1st stage
  appeals process)
• Respond to provider inquiries
• Educate providers about Medicare FFS billing
  requirements
• Establish local coverage determinations (LCDs)
• Review medical records for selected claims
• Coordinate with CMS and other FFS contractors
• A/B MACs
• A/B MACs process Medicare Part A and Medicare
  Part B claims for a defined geographic area or
  jurisdiction, servicing institutional
  providers, physicians, practitioners, and
  suppliers. Four of the A/B MACs also process HHH
  claims in addition to their typical Medicare Part
  A and Part B claims. Note that the four HHH
  areas do not coincide with the jurisdictional
  areas covered by these four A/B MACs.

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Basics Of Medicare Administrative Contractor (MAC)
A/B MAC Jurisdiction 5 (J5) J5 processes FFS
Medicare Part A and Part B claims for Iowa,
Kansas, Missouri, and Nebraska. Contractor
Wisconsin Physicians Service Government Health
Administrators. A/B MAC Jurisdiction 6 (J6)
(Processes HHH claims) J6 processes FFS Medicare
Part A and Part B claims for Illinois, Minnesota,
and Wisconsin. Contractor National Government
Services, Inc. A/B MAC Jurisdiction 8 (J8) J8
processes FFS Medicare Part A and Part B claims
for Indiana and Michigan. Contractor Wisconsin
Physicians Service Government Health
Administrators A/B MAC Jurisdiction 15 (J15)
(Processes HHH claims) J15 processes FFS
Medicare Part A and Part B claims for Kentucky
and Ohio. Contractor CGS Administrators,
LLC A/B MAC Jurisdiction E (JE) JE processes FFS
Medicare Part A and Part B claims for American
Samoa, California, Guam, Hawaii, Nevada and
Northern Mariana Islands. Contractor Noridian
Healthcare Solutions, LLC
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Basics Of Medicare Administrative Contractor (MAC)
A/B MAC Jurisdiction F (JF) JF processes FFS
Medicare Part A and Part B claims for Alaska,
Arizona, Idaho, Montana, North Dakota, Oregon,
South Dakota, Utah, Washington, and Wyoming.
Contractor Noridian Healthcare Solutions,
LLC A/B MAC Jurisdiction H (JH) JH processes FFS
Medicare Part A and Part B claims for Arkansas,
Colorado, Louisiana, Mississippi, New Mexico,
Oklahoma, and Texas. Contractor Novitas
Solutions, Inc. A/B MAC Jurisdiction J (JJ) JJ
processes FFS Medicare Part A and Part B claims
for Alabama, Georgia, and Tennessee. Contractor
Palmetto GBA, LLC A/B MAC Jurisdiction K (JK)
(Processes HHH claims) Implementation for this
MAC is in progress. A/B States Impacted
Connecticut, Maine, Massachusetts, New Hampshire,
New York, Rhode Island, and Vermont. HHH States
Impacted Connecticut, Maine, Massachusetts, New
Hampshire, Rhode Island and Vermont. Contractor
National Government Services, Inc. A/B MAC
Jurisdiction L (JL) Implementation for this MAC
is in progress. States and Territories Impacted
Delaware, District of Columbia, Maryland, New
Jersey and Pennsylvania. Contractor Novitas
Solutions, Inc.
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Basics Of Medicare Administrative Contractor (MAC)
A/B MAC Jurisdiction M (JM) (Processes HHH
claims) JM processes FFS Medicare Part A and Part
B claims for North Carolina, South Carolina,
Virginia, and West Virginia. For Part B services,
A/B MAC Jurisdiction M excludes the counties of
Arlington and Fairfax in Virginia along with the
city of Alexandria in Virginia. Contractor
Palmetto GBA, LLC A/B MAC Jurisdiction N
(JN) Implementation for this MAC is in progress.
A/B States and Territories Impacted Florida,
Puerto Rico, and U.S. Virgin Islands. Contractor
First Coast Service Options, Inc. We hope that
all the basic questions related to Medicare
Administrative Contractor (MAC) are answered in
this article. To know more about A/B MACs, Home
Health and Hospice Areas (HHH), and DME MACs,
please visit CMS page. Medisys Data Solutions is
a leading medical billing company providing
complete assistance in medical billing and coding
for your practice. We shared basic information
about MAC for reference purpose only. If you need
any assistance in billing for Medicare, contact
us at info_at_medisysdata.com/ 302-261-9187
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