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 CMS.gov 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.
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