February 2009 Newsletter
Final MAC Jurisdictions
CMS has completed the Medicare Administrative Contractors (MACs) assignments by announcing the final five MACs responsible for processing Medicare claims in five remaining jurisdictions. Each new MAC is expected to be fully responsible for claims processing in its jurisdiction by March of 2010, and, in the meantime, work toward a smooth transition by educating healthcare providers, state medical associations, and beneficiaries of the implementation process and what to expect.
CMS instituted the MACs in order to consolidate the processing of claims by jurisdiction and to encourage efficient and correct claim submission and payment. Nineteen MACs were awarded contracts spanning 19 jurisdictions. These include 15 A/B MACs, which are responsible for institutional (UB-04) and professional (CMS1500) claims, and four specialty MACs, which are responsible for durable medical equipment suppliers. After the respective “go-live” date, each MAC will be responsible for the receipt, processing, and payment of Medicare fee-for-service claims within the states assigned to its jurisdiction. Previously, Medicare claims were processed by many fiscal intermediaries and carriers, which often resulted in incorrect submission and slower payment. For more details from CMS regarding the MAC transition and implementation, see http://www.cms.hhs.gov/MedicareContractingReform.
Now that the final five A/B MACs have been announced, please note the following to encourage a smooth transition:
- Some providers may need to complete new Electronic Data Interchange Enrollment Forms or ERA Enrollment forms. Quadax Service Representatives contact providers if these forms need to be completed.
- On the UB side, specialty services (home health and hospice) may go to a regional MAC, which is different than the contractor for part A and B claims. When this occurs, a new claim type is needed for UB billing. Quadax identifies these situations and makes the necessary changes so the claims go to the correct MAC.
- As the “go-live” date nears, the MAC may impose “dark days” in order to switch their system to the new provider. During this time, the Medicare claims processing system will not be available for normal business operations and claims will not be processed.
- A “payment floor release” may be temporarily instituted, typically two weeks, to ensure all provider payments are cleared from the previous system by the end of the transition period. During this time, providers will see increased payments; however, providers will see smaller checks as the system starts up for the new workloads because the payment floor will be beginning in the new processing environment.
As the transition process continues, Quadax will keep you informed as issues arise. If you have any questions about how the transition will affect you, contact your Quadax Service Representative.
Final MAC Jurisdictions (new contracts in red)
Jurisdiction # |
States Included in Jurisdiction |
Contract Awarded to |
Go-Live Dates |
1 |
American Samoa, California, Guam, Hawaii, Nevada, and Northern Marianas |
Palmetto GBA |
August 2008 |
2 |
Alaska, Idaho, Oregon, and Washington |
National Heritage Insurance Corp. |
December 2008 |
3 |
Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming |
Noridian Administrative Services |
March 2007 |
4 |
Colorado, New Mexico, Oklahoma, and Texas |
TrailBlazer Health Enterprises |
March to June 2008 |
5 |
Iowa, Kansas, Missouri, and Nebraska |
Wisconsin Physicians Health Insurance Corp. |
December 2007 to June 2008 |
6 |
Illinois, Minnesota, and Wisconsin |
Noridian Administrative Services |
March 2010 |
7 |
Arkansas, Louisiana, and Mississippi |
Pinnacle Business Solutions, Inc. |
February 2009 |
8 |
Indiana and Michigan |
National Government Services |
March 2010 |
9 |
Florida, Puerto Rico, and U.S. Virgin Islands |
First Coast Service Options, Inc. |
March 2009 |
10 |
Alabama, Georgia, and Tennessee |
Cahaba GBA |
March 2010 |
11 |
North Carolina, South Carolina, Virginia, and West Virginia |
Palmetto GBA |
March 2010 |
12 |
Delaware, District of Columbia, Maryland, new Jersey, and Pennsylvania |
Highmark Medicare Services |
July to December 2008 |
13 |
Connecticut and New York |
National Government Services |
July to November 2008 |
14 |
Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont |
NHIC |
May 2009 |
15 |
Kentucky and Ohio |
Highmark Medicare Services |
March 2010 |