Part A/Part B Medicare Administrative Contractor

As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS is completing the process of awarding Medicare claims processing contracts through competitive procedures resulting in replacing its current claims payment contractors - fiscal intermediaries and carriers - with new contract entities called Medicare Administrative Contractors (MACs). CMS initially planned to award a total of 19 MAC contracts through three procurement cycles.  Currently, there are 15 A/B MAC jurisdictions that have served as the foundation for CMS's initial series of A/B MAC procurements.

CMS will consolidate the 15 A/B MAC jurisdictions into 10 A/B MAC jurisdictions.  See detail on this initiative by clicking on the "A/B MAC Jurisdictions" link to the left. 

WPS/Legacy Part A Workload Transfer

As a Title XVIII contractor, Wisconsin Physicians Service (WPS) currently processes a Part A workload that in the past had been processed by Mutual of Omaha and which includes providers from all 15 Part A and Part B Medicare Administrative Contractor (A/B MAC) jurisdictions.  In keeping with CMS policy for assigning providers to A/B MACs, CMS will be reassigning two sets of providers from the WPS legacy fiscal intermediary contract to their destination A/B MACs during calendar 2010.  Please see the link to the Medicare Learning Network article below for more detail

Final Rule Regarding Assignment of Providers and Suppliers to MACs

On November 24, 2006, CMS issued the final rule that would implement certain related provisions of the Medicare Modernization Act, including a portion of the Medicare Contracting Reform provision from section 911, as well as revise the Medicare hospital outpatient prospective payment system.  A portion of the rule deals with the agency's plans to revise parts of the current regulatory language concerning Medicare intermediary and carrier contracting authorities with ones pertinent to the new Medicare Administrative Contractors (MACs).

The rule entitled "Medicare Program-Revisions to Hospital Outpatient Prospective Payment System and Calendar Year 2007 Payment Rates" is 443 pages in length.  The language pertinent to the changes associated with Medicare Contracting Reform is contained in about 9 pages (223-231) of the regulation.

Included in the rule is language explaining that MMA section 911(b) amended section 1816 of the Social Security Act to remove the authority for groups or associations and individual providers of services to nominate (appoint) their intermediary.  It also contains a description of CMS' rule that all providers and suppliers will generally be assigned to a MAC based on geographic location, but that large chain providers will be permitted to request the opportunity to consolidate their billing activities under the MAC with jurisdiction over the chain's home office.

A PDF version of the final rule can be viewed at the A/B MAC Procurement and Implementation link to the left.

Concept of Operations and Enterprise Architecture

The Concept of Operations (ConOps) and Processing Claims for Part A and B Enterprise Architecture (EA) can be viewed by clicking on the A/B MAC Procurement and Implementation link to the left.  These two documents are intended to provide potential bidders some key information they will need to develop proposals that effectively address CMS requirements.  The ConOps document provides a high-level description of the business functions in the new fee-for-service (FFS) environment and of the agency's plans for performing them.  It also includes both the business functions that the MAC will perform and those that other contractors will perform.  The EA presents a detailed view of the FFS business, focusing on the functional and technical environments for processing FFS claims.  Both of these documents describe the Medicare Part A and B environment as it will exist after the MAC contracts are awarded; it is not intended to represent the current environment of the FIs and carriers.  

Round 1 Procurements

The first round of MAC procurements includes all procurements completed or in-progress of as of September 1, 2010.  CMS awarded the A/B MAC contracts through three procurement cycles (start up, cycle one and cycle two).    

Start Up

CMS competed the DME MACs and one A/B MAC as the start-up cycle (see Specialty Jurisdiction page for more information on the DME MACs).

On July 31, 2006, CMS announced that it had awarded the Jurisdiction 3 (J3) A/B MAC contract to Noridian Administrative Services (NAS).  As the J3 A/B MAC, NAS immediately began implementation activities and assumed full responsibility for the work in March 2007.   

Cycle One A/B MACs

In November 2005, CMS began the acquisition process for the seven A/B MAC jurisdictions that comprise Cycle One of the MAC procurement and transition schedule. Cycle One of the A/B MAC acquisitions included the following jurisdictions: J1, J2, J4, J5, J7, J12, and J13. CMS released two RFPs for Cycle One. The first RFP competed approximately 23% of the FFS workload under three A/B MAC jurisdictions: J4, J5 and J12. The second RFP competed about 22% of the FFS workload under jurisdictions J1, J2, J7, and J13.

On August 2, 2007, CMS announced that it had awarded the J4 A/B MAC contract to Trailblazer Health Enterprises (Trailblazer).  As the J4 A/B MAC, Trailblazer immediately began implementation activities and assumed full responsibility for the work in June 2008.  A Background Sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left.    

On September 5, 2007, CMS announced that it had awarded the J5 A/B MAC contract to Wisconsin Physicians Services Health Insurance Corporation (WPS).  As the J5 A/B MAC, WPS immediately began implementation activities and assumed full responsibility for the work in June 2008. A Background Sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left.

On October 24, 2007, CMS awarded the contract for the Jurisdiction 12 (J12) A/B MAC to Highmark Medicare Services, Inc. (HMS).  J12 includes the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania.  On November 5, 2007, Palmetto GBA filed a protest against the award with the Government Accountability Office (GAO).  CMS notified GAO that the agency would take corrective action on certain aspects of the award decision.  The result of this commitment by the agency to take corrective action on the initial evaluation and award was that Palmetto's protest was dismissed by GAO.  The agency has completed its corrective action and has restored the contract award to HMS.  As a result, CMS authorized HMS to resume work under J12 as of March 05, 2008.  HMS assumed full responsibility for the work in December 2008.  A background sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left. 

On October 25, 2007, CMS awarded the J1 A/B MAC contract to Palmetto GBA (Palmetto).  J1 includes the states/territories of American Samoa, California, Guam, Hawaii, Nevada and the Northern Mariana Islands.  On November 13, 2007, National Heritage Insurance Company (NHIC) filed a protest of the award with the Government Accountability Office (GAO) triggering an automatic stay on performance of work until a decision could be rendered. On February 12, 2007, CMS received notification that GAO denied NHIC's protest of the award to Palmetto.  As a result of this decision, CMS authorized Palmetto to resume work under J1 as of February 14, 2008.  Palmetto assumed full responsibility for the work in September 2008.  A background sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left.

On March 18, 2008, CMS awarded the J13 A/B MAC contract to National Government Services (NGS).  As the J13 A/B MAC, NGS immediately began implementation activities and assumed responsibility for the work in November 2008.  A Background Sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left. 

On May 06, 2008, CMS awarded the J2 A/B MAC contract to National Heritage Insurance Corporation (NHIC).  However, on May 27, 2008 a protest against the award was filed with GAO.  On July 21, 2010, CMS posted a notice cancelling the solicitation for the Jurisdiction 2 A/B MAC.  This A/B MAC workload will now be consolidated with the Jurisdiction 3 MAC workload when it is recompeted.  

On June 11, 2008, CMS announced it had awarded the J7 A/B MAC contract to Pinnacle Business Solutions, Inc, (PBSI).  However, on July 2, 2008 a protest against the award was filed with GAO.  On October 6, 2008, GAO sustained the protest of the award and recommended corrective steps.  As a result, CMS took corrective action on certain aspects of the award decision and announced on July 10, 2009 that TrailBlazer Health Enterprises, LLC was awarded the contract for J7 comprised of Arkansas, Louisiana and Mississippi.  However, on July 20, 2009, a protest against the award was filed with GAO.  Following this second protest, CMS posted a notice cancelling the Jurisdiction 7 A/B MAC procurement.  This A/B MAC workload will now be consolidated with the Jurisdiction 4 MAC workload when it is recompeted.   

Cycle Two A/B MACs

The Cycle Two acquisition process involved separate competitions for seven A/B MAC jurisdictions.  Cycle Two of the A/B MAC acquisitions included the following jurisdictions: J6, J8, J9, J10, J11, J14 and J15.

In March 2007, CMS announced that the home health and hospice workloads would be consolidated into four of the A/B MAC contracts instead of being procured separately under Cycle Two.  CMS will integrate the four home health and hospice jurisdictional claims workloads into the following four A/B MAC competitions:

• Jurisdiction 6 will include home health and hospice Jurisdiction D,
• Jurisdiction 11 will include home health and hospice Jurisdiction C,
• Jurisdiction 14 will include home health and hospice Jurisdiction A and
• Jurisdiction 15 will include home health and hospice Jurisdiction B.

On September 12, 2008, CMS announced it had awarded the J9 A/B MAC contract to First Coast Service Options, Inc. (FCSO).  As the J9 A/B MAC, FCSO immediately began implementation activities and  assumed full responsibility for the work  in March 2009.  A Background Sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left. 

On November 19, 2008, CMS announced it had awarded the J14 A/B MAC contract to National Heritage Insurance Corporation (NHIC).  As the J14 A/B MAC, NHIC immediately began implementation activities and assumed full responsibility for the work in June 2009.  NHIC's contract also includes the Regional Home Health and Hospice Intermediary (RHHI) workload in Jurisdiction A comprised of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.  A Background Sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left.

On January 7, 2009, CMS announced it had awarded the remaining 5 Cycle Two A/B MAC contracts. 

Noridian Administrative Services, LLC (NAS) was awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 6 comprised of Illinois, Minnesota and Wisconsin.  The contract also included the home health and hospice claims workload from providers in Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Islands, Oregon, Puerto Rico, U.S. Virgin Islands, Wisconsin and Washington.  However, four protests against the award were filed with the GAO. CMS is undertaking corrective action on the award.  CMS anticipates completing this corrective action during the spring of 2011.  The legacy fiscal intermediaries and carriers will continue to service the providers in those workloads until further notice.   

National Government Services, Inc (NGS) was awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 8 comprised of Indiana and Michigan.  On January 26, 2009, a protest against the award was filed with the GAO.  CMS is undertaking corrective action on the award.  CMS anticipates completing this corrective action during the spring of 2011.  The legacy fiscal intermediaries and carriers will continue to service the providers in those workloads until further notice.    

Cahaba Government Benefit Administrators, LLC (Cahaba GBA) was 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 assumed full responsibility for the work in September, 2009.  A Background Sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left.

Palmetto Government Benefits Administrator, LLC (Palmetto GBA) was 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.  The contract also included the home health and hospice claims workload from providers in Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio,  Oklahoma, South Carolina, Tennessee and Texas.  However, on February 2, 2009 a protest against the award was filed with GAO.  As a result of questions raised during GAO's review of the protest, CMS took voluntary corrective action on certain aspects of the award decision.  CMS announced completion of its corrective action on May 21,2010 and that Palmetto GBA was awarded the contract for J11.  A new protest was filed with the GAO.  GAO issued a decision in early September 2010 sustaining the agency's contract award, and CMS and Palmetto GBA are now actively implementing the Jurisdiction 11 contract. The legacy fiscal intermediaries and carriers will continue to service the providers until the MAC contract is implemented.

Highmark Medicare Services, Inc (HMS) was awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 15 comprised of Kentucky and Ohio.  The contract also included the home health and hospice claims workload from providers in Colorado, Delaware, District of Columbia, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia and Wyoming.  However, two protests against the award were filed with GAO.   As a result of issues raised during GAO's review of the protest, CMS took voluntary corrective action on certain aspects of the award decision.  CMS announced the completion of its corrective action on July 8, 2010, and that CIGNA Government Services (CGS) was awarded the contract for J15.  However, several protests against the award were filed with the GAO.  At the end of October 2010, GAO issued a decision sustaining the agency's contract award, and CMS and CGS are now actively implementing the Jurisdiction 15 contract.  The legacy fiscal intermediaries and carriers will continue to service the providers until the MAC contract is implemented.

Round 2 Procurements

Round 2 refers to the second round of A/B MAC solicitations that will be issued on or after September 1, 2010.  This includes the legacy workloads in Jurisdictions 2 and 7. These respective solicitations were not active as of September 1, 2010, and the respective workloads are now being incorporated into new and open solicitations that will be issued in the near future. 

Over the next several years, CMS will consolidate ten A/B MAC workloads to form five consolidated A/B MAC workloads:

• Jurisdictions 2 and 3 will be combined to form A/B MAC Jurisdiction F;
• Jurisdictions 4 and 7 will be combined to form A/B MAC Jurisdiction H;
• Jurisdictions 14 and 13 will be combined to form A/B MAC Jurisdiction K;
• Jurisdictions 8 and 15 will be combined to form A/B MAC Jurisdiction I; and
• Jurisdictions 5 and 6 will be combined to form A/B MAC Jurisdiction G.

See the consolidated jurisdictions map link below.  See the link to the "Spotlight" page for more information on the process of consolidation. 

On July 22, 2010 CMS posted a Request for Information (RFI) on FedBizOpps regarding the upcoming plans for the A/B MAC Round 2 procurements.   

On August 24, 2010 CMS posted a second (RFI) on FedBizOpps regarding A/B MAC contract award limit policy. 

On August 22, 2011, CMS announced that Noridian Administrative Services (NAS) was awarded the Round 2 contract for A/B MAC Jurisdiction F.  However, on August 31, 2011, a protest was filed regarding the contract award with the Government Accountability Office (GAO).   In accordance with the Competition in Contracting Act (CICA), the filing of the protests triggered an automatic stay on performance of the NAS contract pending GAO's review of the protest allegations.  GAO normally issues its findings on bid protests within 100 days after the filing date.  In this case, the deadline for the GAO decision on the protest is December 9, 2011.  During the GAO review period, the beneficiaries and providers in this jurisdiction will continue to receive Medicare claims processing and payment services by the MAC, carrier and/or fiscal intermediary currently operating in the jurisdiction. 

On March 4, 2011, CMS issued a solicitation for A/B MAC Jurisdiction H.  Jurisdiction H includes the consolidated A/B MAC Jurisdiction 4 states of Colorado, New Mexico, Oklahoma, and Texas (currently serviced by Trailblazer Health Enterprises), as well as the states of Arkansas, Louisiana, and Mississippi (currently serviced by Pinnacle and by Cahaba).  The solicitation anticipates that the A/B MAC Jurisdiction H contract will be awarded in early June 2011.

On June 23, 2011, CMS issued a solicitation for the A/B MAC Jurisdiction 5.  Jurisdiction 5 includes the following states:  Iowa, Kansas, Missouri, and Nebraska.  In addition, this jurisdiction includes certain Part A providers that are being reassigned from a legacy fiscal intermediary contract.  Wisconsin Physician Services is currently serving as the A/B MAC for the states in Jurisdiction 5.  CMS anticipates awarding this contract in March 2012.