Review Contractor Directory - Interactive Map

The Review Contractor Directory - Interactive Map allows you to access state-specific CMS contractor contact information. You may receive correspondence from one or several of these contractors in your state. They may request medical records from you, as they perform business on behalf of CMS. You can use this website to access their contact information including emails, phone numbers and websites.

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State Placeholder

CMS Divisions Responsible for Contractors

Provider Compliance Supplemental Medical Review (SMRC)
All of the United States of America Strategic Health Solutions, LLC
4211 South 102nd Street
Omaha, NE 68127
402-452-3333
www.strategichs.com
Accepts esMD Transactions

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National Benefit Integrity MEDIC (NBI MEDIC)
All 50 States National Benefit Integrity MEDIC
Health Integrity, LLC
9240 Centreville Rd.
Easton, MD 21601
410-770-8583
Report Fraud, Waste or Abuse: 1-877-7SAFE-RX
www.healthintegrity.org

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Outreach & Education MEDIC (O&E MEDIC)
All 50 States Outreach & Education MEDIC (Fraud, Waste & Abuse Education for Medicare Advantage, and Part D Plans)
Rainmakers Strategic Solutions
7106 Ambassador Road, Suite 150
Windsor Mill, MD 21244
443-348-8067
www.rainmakerssolutions.com

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Part D Recovery Audit Contractor (Part D RAC)
All 50 States Part D RAC
ACLR Strategic Business Solutions, LLC
38705 7 Mile Road, Suite 460
Livonia, MI, 48152-3975
1-866-722-6233
aclrsbs.com

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Division of Plan Oversight & Accountability (DPOA)
All 50 States The Division of Plan Oversight and Accountability (DPOA) serves as the focal point for Fraud, Waste, and Abuse oversight of Medicare Advantage and Prescription Drug Plans. DPOA also performs oversight of the NBI MEDIC, O & E MEDIC and the Part D RAC.
  State Point of Contact
Comprehensive Error Rate Testing (CERT)
All 50 States E-Mail: cert@cms.hhs.gov
Website: www.cms.gov/cert
CERT Documentation Contrator (DC) - Livanta LLC.
CERT Review Contractor (RC) - AdvanceMed Corp.
CERT Statistical Contractor (SC) - The Lewin Group

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  State Point of Contact
Payment Error Rate Measurement (PERM)
All 50 States E-Mail: permproviders@cms.hhs.gov
Website: www.cms.gov/perm
PERM Statistical Contractor (SC) - The Lewin Group
PERM Review Contractor (RC) - A+ Government Solutions

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  Division of Compliance, Projects and Demonstrations (DCDP)
All 50 States To assure the integrity of Medicare Trust Fund dollars through program integrity and compliance efforts by actively seeking out suspected Medicare program vulnerabilities through a variety of methods, assessing scope and severity of risks, and working collaboratively within and outside CMS to develop, help implement, and monitor corrective actions.

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  Division of Recovery Audit Operations (DRAO)
All 50 States

The RACs detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions that will prevent future improper payments:

  • Providers can avoid submitting claims that do not comply with Medicare rules
  • CMS can lower its error rate
  • Taxpayers and future Medicare beneficiaries are protected

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  Medical Review
All 50 States

The collection of information and clinical review of medical records by Medicare Administrative Contractors to ensure that payment is made only for services that meet the Medicare coverage, coding and medical necessity requirements.

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National Benefit Integrity MEDIC (NBI MEDIC)
All 50 States National Benefit Integrity MEDIC
Health Integrity, LLC
9240 Centreville Rd.
Easton, MD 21601
410-770-8583
Report Fraud, Waste or Abuse: 1-877-7SAFE-RX
www.healthintegrity.org

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Outreach & Education MEDIC (O&E MEDIC)
All 50 States Outreach & Education MEDIC
Rainmakers Solutions
14319 Roxbury Lake Drive
Glenelg, MD 21737
443-255-3796
www.rainmakerssolutions.com

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Part D Recovery Audit Contractor (Part D RAC)
All 50 States Part D RAC
ACLR Strategic Business Solutions, LLC
38705 7 Mile Road, Suite 460
Livonia, MI, 48152-3975
866-722-6233
aclrsbs.com

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Division of Plan Oversight & Accountability (DPOA)
All 50 States The Division of Plan Oversight and Accountability (DPOA) serves as the focal point for Fraud, Waste, and Abuse oversight of Medicare Advantage and Prescription Drug Plans. DPOA also performs oversight of the NBI MEDIC, O & E MEDIC and the Part D RAC.

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Definition of Contractors

CERT Comprehensive Error Rate Testing (CERT) program is to measure improper payments in the Medicare fee-for-service (FFS) program. The CERT program cannot be considered a measure of fraud. Since the CERT program uses random samples to select claims, reviewers are often unable to see provider billing patterns that indicate potential fraud when making payment determinations. CERT is designed to comply with the Improper Payments Elimination and Recovery Act of 2010.

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DME MAC Durable Medical Equipment - Medicare Administrative Contractor is a specialty MAC whose contract is awarded through competitive procedures and which provides for the processing of Medicare claims for durable medical equipment, prosthetics, orthotics, and supplies in keeping with 42 CFR 421.210.

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HHH Home Health and Hospice

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IH Indian Health

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MAC Medicare Administrative Contractor is a contractor that performs Medicare fee-for-service claims administration services that is awarded a contract through competitive procedures in keeping with Section 1874A of the Social Security Act.

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NBI MEDIC The National Benefit Integrity (NBI) Medicare Drug Integrity Contractor (MEDIC) is a contractor responsible for monitoring all fraud, waste or abuse initiatives in the Medicare Advantage (Part C) and Prescription Drug Plan (Part D) benefits in all 50 states, the District of Columbia, and U.S. Territories.

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O&E MEDIC The Outreach & Education MEDIC is a contractor that provides Medicare Advantage and Part D program integrity fraud, waste and abuse (FWA) education to stakeholders by developing comprehensive educational and training tools, relevant FWA news and industry resources, as well as facilitates FWA information sharing opportunities.

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PART D RAC The Part D Recovery Audit Contractor (RAC) is a contractor that performs data analysis on Prescription Drug Events (PDE) submitted by Part D plan sponsors in order to detect improper payments. The RAC is paid a contingency fee for amounts recovered.

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PERM The Payment Error Rate Measurement (PERM) program measures improper payments in Medicaid and CHIP and produces error rates for each program. The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of Medicaid and CHIP in the fiscal year (FY) under review. It is important to note the error rate is not a "fraud rate" but simply a measurement of payments made that did not meet statutory, regulatory or administrative requirements.

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Recovery Auditor(s) Recovery Auditors, are tasked with identifying and recovering Medicare overpayments and identifying underpayments.

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RHHI Regional Home Health and Hospice Intermediary

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RRB Railroad Retirement Board

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SMRC The Supplemental Medical Review Contractor is a contractor that performs Medicare medical review activities as directed by CMS. This is a contract that is awarded through competitive procedures in keeping with Section 1874A of the Social Security Act.

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ZPIC The primary goal of the Zone Program Integrity Contractors (ZPICs) is to identify cases of suspected fraud, develop them thoroughly and in a timely manner, and take immediate action to ensure that Medicare Trust Fund monies are not inappropriately paid out and that any mistaken payments are recouped. There are seven ZPIC zones and the ZPICs for these zones are tasked with performing program integrity for Medicare Parts A, B, C, Durable Medical Equipment (DME), Home Health and Hospice (HH +H), and the Medicare-Medicaid data match program (Medi-Medi).

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