The Centers for Medicare & Medicaid Services (CMS) uses a network of contractors called Medicare Administrative Contractors (MAC) to process Medicare claims, enroll health care providers in the Medicare program and educate providers on Medicare billing requirements. MACs also handle claims appeals and answer beneficiary and provider inquiries. Even though Section 1861 of the Social Security Act (“the act”) defines the items and services for which Medicare may pay, in many cases, MACs may have more defined policies than what is included in Medicare's National Coverage Determinations (NCDs). MACs publish a Local Coverage Determination (LCD) for the jurisdiction(s) they serve to clarify policies.

Consolidation

CMS determined that contracted Medicare claims operations could increase in efficiency and effectiveness by consolidating some of the smaller Part A and Part B MAC workloads to form larger A/B MAC jurisdictions. In March 2014, this consolidation process was temporarily halted. Click here to read more about the consolidation halt.

Links:

• Medicare MAC information
• Part A/Part B MAC information
• Medicare Carriers Manual - Local Coverage Determinations
• Find Your MAC tool - helps you find your state's MAC information.