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Medicare Contractors

The Healthcare Integrated General Ledger Accounting System (HIGLAS) is not changing the basic role of Medicare contractors. Contractors will continue to be responsible for the Medicare claims processing activities they currently perform.

Accounting functions that are now executed in Medicare contractor selected shared claims processing systems will be incorporated into HIGLAS. For example, once a Medicare claim has been approved for payment, HIGLAS, not the selected shared system will perform the payment calculations, formatting, and accounting. The General Ledger feature in HIGLAS gives CMS enhanced oversight of contractor accounting systems and provide high quality, timely data for decision-making and performance measurement. Contractors use HIGLAS to perform these functions on a daily basis.

HIGLAS communicates with Medicare Contractors' shared systems to process claim billing information, provider profile information, beneficiary profile information, check reconciliation, payment information, and other claim related data. These Medicare Contractor shared systems are the Federal Intermediary Standard System (FISS) and the Multi-Carrier System (MCS).

FISS is a single standard Medicare Part A claims processing system used to process Medicare claims related to medical care provided by hospital and hospital based providers. FISS exchanges data with HIGLAS for accounting and processing Part A claims and some Part B claims.

MCS is a single standard Medicare Part B claims processing system used by a majority of Medicare Part B contractors to process Medicare claims related to non-hospital based physician care. MCS exchanges data with HIGLAS for accounting and processing of Part B claims.