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CMS Announces MAC Contract for Connecticut and New York

April 8, 2008:
National Government Services is the latest Medicare administrative contractor to be selected through competitive bidding to administer claims in one of 15 national jurisdictions. The bulk of jurisdictions have yet to be awarded.

The Centers for Medicare & Medicaid Services (CMS) announced March 18 that National Government Services has been selected to administer Medicare claims in jurisdiction 13, which includes Connecticut and New York, work that is currently performed by two fiscal intermediaries and four carriers in the two states.

With an eye to improving service to beneficiaries and health care providers and providing CMS with greater oversight of the contractors that process and pay claims, Medicare contracting reform provisions in the Medicare Modernization Act of 2003 mandated that CMS replace the current Part A fiscal intermediaries and Part B contractors with Medicare administrative contractors (MAC).

Under the current system, carriers process Medicare Part B claims for physicians, laboratories, and other practitioners while fiscal intermediaries process Medicare Part A claims for providers, such as hospitals, skilled nursing facilities, and other institutional providers. As the MAC for Connecticut and New York, National Government Services (NGS) will be processing both Medicare Part A and Part B fee-for-service claims submitted by hospitals and other health care providers. Implementation will begin immediately, and NGS will assume full responsibility for all Part A and B claims processing in the two-state jurisdiction no later than November 2008.

CMS’s primary objectives for the MACs include enhanced provider customer service, increased payment accuracy, and cost savings resulting from efficiencies. For providers and beneficiaries, the new system will provide a single contact with Medicare. When the new A/B MAC for Connecticut and New York becomes operational, it will be the contact for all Medicare providers and physicians in both states. Beneficiaries will have a beneficiary contact center to address claims-related questions.

The first A/B MAC contract was awarded in July 2006 to Noridian Administrative Services. By 2011, a total of 15 Part A/Part B Medicare administrative contractors will cover every state, including the District of Columbia. A primary consideration in designing the MAC jurisdictions was to balance the allocation of workloads. CMS believes the new MAC jurisdictions achieve one of its primary objectives—balancing workloads in terms of the number of fee-for-service beneficiaries and providers.

Medicare’s A/B MAC Jurisdictions
Jurisdiction #States Included in Jurisdiction
1American Samoa, California, Guam, Hawaii, Nevada, and Northern Mariana Islands
2Alaska, Idaho, Oregon, and Washington
3Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming
4Colorado, New Mexico, Oklahoma, and Texas
5Iowa, Kansas, Missouri, and Nebraska
6Illinois, Minnesota, and Wisconsin
7Arkansas, Louisiana, and Mississippi
8Indiana and Michigan
9Florida, Puerto Rico, and U.S. Virgin Islands
10Alabama, Georgia, and Tennessee
11North Carolina, South Carolina, Virginia and West Virginia
12Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania
13Connecticut and New York
14Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
15Kentucky and Ohio

Sarah A. Serling, CPC, CPC-H, CPC-I, CCS-P, CCS
Clinical/Technical Editor


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