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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.

Map of the United States

Select a State:

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

	National Benefit Integrity MEDIC (NBI MEDIC)
All 50 States	NBI MEDIC, ZPIC 4, and UPIC West Corporate Headquarters: Health Integrity, LLC 28464 Marlboro Avenue Easton, MD 21601 410-770-8583 Report Fraud, Waste or Abuse: 1-877-7SAFE-RX www.healthintegrity.org

	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

	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

	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 Accepts esMD transactions

	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 Accepts esMD transactions

	Division of Compliance, Projects and Demonstrations (DCPD)
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.

Recovery Audit Contractors (RACs)

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

	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.

	National Benefit Integrity MEDIC (NBI MEDIC)
All 50 States	NBI MEDIC, ZPIC 4, and UPIC West Corporate Headquarters: Health Integrity, LLC 28464 Marlboro Avenue Easton, MD 21601 410-770-8583 Report Fraud, Waste or Abuse: 1-877-7SAFE-RX www.healthintegrity.org

	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

	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

	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.

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.

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.

HHH	Home Health and Hospice

IH	Indian Health

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.

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.

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.

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.

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.

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

RHHI	Regional Home Health and Hospice Intermediary

RRB	Railroad Retirement Board

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.

UPIC

The Unified Program Integrity Contractors (UPICs) perform fraud, waste, and abuse detection, deterrence and prevention activities for Medicare and Medicaid claims processed in the United States. Specifically, the UPIC’s perform integrity related activities associated with Medicare Parts A, B, Durable Medical Equipment (DME), Home Health and Hospice (HH+H), Medicaid, and the Medicare-Medicaid data match program (Medi-Medi). The UPIC contracts operate in five (5) separate geographical jurisdictions in the United States and combine and integrate functions previously performed by the Zone Program Integrity Contractor (ZPIC), Program Safeguard Contractor (PSC) and Medicaid Integrity Contractor (MIC) contracts.

Page last Modified: 06/07/2012 8:57 AM
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