Posted in #Medicare, Training

Do you know what is your Local CMS MAC?

As a provider you see Medicare patients and file their claims to Medicare every day, but do you know who is the one the processes those claims?

Well, the short answer is your Local CMS MAC.

What is a Local MAC? MAC stands for Medicare Administrative Contractor- a private healthcare insurer that processes the fee-for-services claims for Medicare Part A/B beneficiaries, Home Health, and DME claims.

According to as of 2019 there are 13 Medicare A/B MACs and 4 DME MACs. They are responsible for processing  claims for ” nearly 68% of Medicare population”.

MACs provide LCDs- Local Coverage Determinations for services that are done by you-provider.  By contacting your local MAC you can find out if a service or medication is covered or not. This step will help you reduce the number of your unnecessary denials and decrease the amount of days in your A/Rs.  

I am located in New York, so my local MAC is for Jurisdiction K- Medicare Part B claims ONLY.  The company that provides LCDs and processes my claims is NGS or National Government Services. 

Below are the most current A/B MAC + DME MAC jurisdictions.


Posted in In The Know Series, Insurance, Training

EmblemHealth Plans that DO NOT require a REFERRAL-2019

The following is the list of all the EmblemHealh Plans for 2019 that do not require a referral from their primary to see a specialist.

Commercial Plans:

Access I/II, EmblemHealth Platinum Choice, EmblemHealth Gold Choice, EmblemHealth Silver Choice, EmblemHelath Gold Premier 1, EmblemHealth Silver Plus1, EmblemHealth Silver Premier, EmblemHealth Platinum Premier, EmblemHealth Gold Premier, EmblemHealth EPO Value, EmblemHealth EPO Value HDHP

Medicare Advantage Plans:

EmblemHealth VIPĀ  Go (HMO-POS) plans, EmblemHealth Affinity Medicare Passport Essentials (HMO), EmblemHealth Affinitiy Medicare Passport Essentials NYC (HMO), EmblemHealth Affinity Medicare Utimate (HMO SNP), and EmblemHealth Affinity Medicare Solutions (HMO SNP)

Remember if the EmblemHealth HIP plan has a Montefiore Logo and you are going to the provider associated with Montefiore you still also DO NOT Require a referral to see that specialist.

Posted in In The Know Series, Insurance, My services, NY Medicaid EHR incentive program, Training

Aetna adding #LabCorp to it’s preferred laboratory list for 2019

According to Aetna- starting on January 1, 2019; LabCorp will also be the preferred national laboratory for Aetna Commercial and Medicare health plan members.

LabCorp is joining Quest Diagnostics as a preferred laboratory for Aetna members.

Providers are able to refer Aetna patients either to Quest Diagnostics or LabCorp for a full range of services, including their vast number of convenient locations.