Spotlight

Status of MAC Contract Awards (as of September 17, 2012)

Award Announcement:  On September 17, 2012, CMS made a contract award for the Jurisdiction L A/B MAC contract to Novitas Solutions, Inc.  The Jurisdiction L A/B MAC administers Medicare Part A and Part B claims for covered services in the states of Delaware, Maryland, New Jersey, and Pennsylvania, as well as the District of Columbia.  For more information about the Jurisdiction L award, use the following hyperlink: Jurisdiction L Award Fact Sheet

On August 31, 2012, CMS made a contract award for the Jurisdiction C Durable Medical Equipment (DME) MAC contract to CGS Administrators, LLC.  The Jurisdiction C DME MAC administers Medicare supplier claims for DME furnished to program beneficiaries who reside in the states of Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia, as well as Puerto Rico and the U.S. Virgin Islands.  For more information about the Jurisdiction C award, use the following hyperlink:  Jurisdiction C Award Fact Sheet

On July 31, 2012, CMS made a contract award for A/B MAC Jurisdiction 5.  The Jurisdiction 5 contract award, made to Wisconsin Physicians Service (WPS), covers Iowa, Kansas, Missouri, and Nebraska and also includes Part A providers serviced by WPS under a legacy fiscal intermediary contract.  For more information about the Jurisdiction 5 Award, use the following hyperlink:  Jurisdiction 5 Award Fact Sheet

Protest Update: In September 2011, CMS made contract awards for A/B MAC Jurisdictions 6 and 8.  The Jurisdiction 6 contract award, made to National Government Services, covers Illinois, Minnesota, and Wisconsin.  The Jurisdiction 8 contract award, made to Wisconsin Physicians Service, covers Indiana and Michigan.  In November 2011, CMS awarded the contract for A/B MAC Jurisdiction H.  The Jurisdiction H contract award, made to Highmark Medicare Services (now called Novitas Solutions, Inc.), consolidates Medicare services for the States of Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas.  Subsequently, protests were filed against all three MAC contract awards.  In keeping with federal procurement law, CMS implemented stop-work orders for all three contracts to enable the Government Accountability Office (GAO) to review the procurement record for each.  Following is an update concerning these three protests:

• Based on issues identified during the course of GAO's review of the AB MAC Jurisdiction 6 contract award, CMS has initiated voluntary procurement corrective action, and the stop-work order remains in effect.  CMS expects that the procurement corrective action will take approximately six months to complete.  During this time, providers and beneficiaries in Illinois, Minnesota, and Wisconsin will continue to be served by their current Medicare fiscal intermediaries and carriers. 
• The GAO has denied the protest for the AB MAC Jurisdiction 8 contract.  As of August 20, 2012, CMS has implemented all Medicare claims processing workloads for Indiana and Michigan into the AB MAC Jurisdiction 8 contract.   Wisconsin Physicians Service Insurance Corporation is the A/B MAC contractor for Jurisdiction 8.  
• On March 1, 2012, the GAO denied the protest for the AB MAC Jurisdiction H contract.  CMS will now move forward to implement all medicare claims processing workloads for the seven affected states (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas) into the AB MAC Jurisdiction H contract by the end of 2012.  Novitas will provide affected providers with specific information about how the implementation will work.  In the meantime, until affected Medicare workloads convert to the Jurisdiction H MAC, providers will continue to submit claims to their current Medicare contractor.  To access the Jurisdiction H Implementation Schedule click on the following hyperlink:  Jurisdiction H Implementation Schedule

General Status of MAC Procurements:  During initial implementation (2005-2010) of MAC procurements, Medicare's claims processing operations have realized significant operational savings from the consolidation of state workloads and the efficiencies gained through integrating Part A and Part B functionality.  CMS believes that the efficiency and effectiveness of its contracted Medicare claims operations can be further increased by consolidating some of the smaller A/B MAC workloads to form larger A/B MAC jurisdictions, further reducing the size range among the A/B MACs.  In addition, CMS believes that reducing the number of A/B MAC contracts to ten will improve the efficiency and effectiveness of CMS's internal MAC procurement and contract administration processes.

To achieve its ultimate goal of ten A/B MAC contracts, CMS intends to:

• Re-compete five A/B MAC contracts/jurisdictions based on their present area boundaries as the current A/B MAC contracts run their course; and
• Over the next several years, consolidate five pairs of A/B MAC workloads to form five consolidated A/B MAC contracts.

The approximate timing for each consolidation is addressed in the table below, although the exact timing of consolidation actions may be adjusted based on program considerations (contractual status, schedule, etc.).

For more information on the status of the A/B MAC awards click on the Part A/Part B Medicare Administrative Contractor link to the left.  For a map of the DME MAC and Home Health and Hospice jurisdictions click on the Specialty MAC Jurisdiction link to the left.

WPS/Legacy Part A Workload Transfer (West Coast Providers (CA-HI-NV), Southwestern Providers (TX-OK-NM-CO), and Mid-Atlantic Providers (DC-DE-MD-NJ-PA) Formerly Serviced by Mutual of Omaha)

In keeping with CMS policy for assigning providers to A/B MACs, CMS re-assigned three sets of providers from the WPS legacy fiscal intermediary contract to their destination A/B MACs during calendar 2010 and early 2011.  Please see the Medicare Learning Network article link below for more detail.

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