Basics of Medicare Administrative Contractor (MAC)

Basics of Medicare Administrative Contractor (MAC)

What’s 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.

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 (LCD’s)
  • 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 HH+H claims in addition to their typical Medicare Part A and Part B claims. Note that the four HH+H areas do not coincide with the jurisdictional areas covered by these four A/B MACs.

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 HH+H 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 HH+H 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

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 HH+H claims)

Implementation for this MAC is in progress. A/B States Impacted:  Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont. HH+H 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.

A/B MAC Jurisdiction M (JM) (Processes HH+H 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 (HH+H), 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@medisysdata.com/ 302-261-9187

Share this post