CMS SELECTS FINAL FIVE MEDICARE CONTRACTORS TO ADMINISTER MEDICARE CLAIMS PAYMENTS IN 14 STATES
MEDICARE ADMINISTRATIVE CONTRACTORS TO HELP MEET GOALS OF IMPROVING CLAIMS PROCESSING FOR PROVIDERS
The Centers for Medicare & Medicaid Services (CMS) today announced the final five contractors that will process and pay Medicare claims for health care services under the Medicare Fee-for-Service program.
The new contracts that will be administered for up to five years will process and pay 36 percent of the national volume of Medicare Part A (hospital insurance) and Part B (medical insurance) claims payments in 14 states, mostly in the South and Midwest. These are services furnished by hospitals, physicians and other health care providers to people with Medicare. CMS now has met its goal of awarding all 15 Medicare Administrative Contractor (MAC) contracts.
“With these last awards, CMS completes a major step in its effort to improve the way in which the government contracts for claims administration for the largest part of Medicare across the United States,” Acting CMS Administrator Kerry Weems said. “CMS will receive the best value for the critical function of processing and paying Medicare claims. This is another step toward ensuring that we have a highly functioning processing and payment system that helps to improve services to beneficiaries and health care providers in the Medicare fee-for-service benefit plan.”
The competitive selection of the new Part A and Part B MACs was made on a “best value” basis. Primary consideration was given to the technical quality of the offerors’ proposals. CMS conducted a technical and past performance evaluation, performed a cost realism analysis and assessed overall cost reasonableness for each award.
The final five Part A and Part B MAC contractors will immediately begin their implementation activities and will assume full responsibility for the claims processing work in their respective jurisdictions no later than March 2010. During the implementation period, the Part A and Part B MAC contractors will be conducting extensive outreach to health care providers, state medical associations and beneficiaries in their jurisdictions to provide education and information about the implementation. The five new MACs are:
· Noridian Administrative Services, LLC (NAS) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 6 comprised of Illinois, Minnesota and Wisconsin. NAS is headquartered in Fargo, N.D. NAS’ can reached at http://www.noridianmedicare.com/.
· National Government Services (NGS) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 8 comprised of Indiana and Michigan. NGS is headquartered in Indianapolis, Ind. The NGS website is http://www.ngsmedicare.com/HomePage.aspx.
· Cahaba Government Benefit Administrators, LLC (Cahaba GBA) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 10 comprised of Alabama, Georgia and Tennessee. Cahaba GBS is headquartered in Birmingham, Ala. The Cahaba GBA’s website is http://cahabagba.com/.
· Palmetto Government Benefits Administrators, LLC (Palmetto GBA) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 11 comprised of North Carolina, South Carolina, Virginia and West Virginia. Palmetto GBA has its operational headquarters in Columbia, S.C., with some operations performed in Columbus, Ohio. Palmetto GBA’s website is http://www.palmettogba.com/palmetto/palmetto.nsf/SiteHome?ReadForm.
· Highmark Medicare Services (HMS) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 15 comprised of Kentucky and Ohio. HMS is headquartered in Camp Hill, Pa. HMS’s website is http://www.highmarkmedicareservices.com/.
Under the current system, fiscal intermediaries process claims for Medicare Part A providers, such as hospitals, skilled nursing facilities and other institutional providers. Carriers process claims for physicians, laboratories and other practitioners under Medicare Part B. The new system consolidates those contractors, making it simpler for practitioners to have a single point of contact with Medicare. The Part A and B MACs will be the contact for all Medicare providers and physicians, while beneficiaries will pose their claims-related questions to a Beneficiary Contact Center that can be reached at 1-800-MEDICARE (800-633-4227).
As a result of a full and open competitive procurement, the new contractors, will take over the claims payment work now performed by numerous fiscal intermediaries and carriers. The MAC contracts, which have an approximate value of $1.4 billion over five years, will fulfill the requirements of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) contracting reform provisions.
The awards announced today close procurement activities under the MMA that began in April 2005 with the issuance of a request for proposal. This action represented the first time full and open competition had been used to select Medicare fee-for-service contractors to perform claims administration services.
A total of 19 new contracts have been awarded under MMA provisions. When fully operational the Part A and Part B MACs will completely replace the fiscal intermediaries and carriers that have administered Medicare since its inception.
All contracts include a base period and four one-year options and will provide the contractors with the opportunity to earn award fees based on their ability to meet or exceed performance requirements set by CMS.
These requirements are rooted in CMS’ key objectives for MACs, including enhanced provider customer service, increased payment accuracy, improved provider education and training leading to correct claims submissions, and realized cost savings resulting from efficiencies and innovation. In accordance with the MMA, MAC contracts will be recompeted at least every five years.
CMS awarded the first Part A and Part B MAC contracts in July 2006. A complete list of contractors and the states they cover, along with other information, can be found at www.cms.hhs.gov/MedicareContractingReform/.
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