Provider Compliance Group Interactive Map
The Provider Compliance Group Interactive Map allows you to access state-specific CMS contractor contact information. You may receive correspondence from one or several of these contractors in your state. They may request medical records from you, as they perform business on behalf of CMS. You can use this website to access their contact information including emails, phone numbers and websites.
CMS Divisions Responsible for Contractors
| National Benefit Integrity MEDIC (NBI MEDIC) | |
|---|---|
| All 50 States | National Benefit Integrity MEDIC Health Integrity, LLC 9240 Centreville Rd. Easton, MD 21601 Office: (410) 770-8583 Report Fraud, Waste or Abuse: 1-877-7SAFE-RX http://www.healthintegrity.org/ |
| Outreach & Education MEDIC (O&E MEDIC) | |
|---|---|
| All 50 States | Outreach & Education MEDIC Rainmakers Solutions 14319 Roxbury Lake Drive Glenelg, MD 21737 Office: 443-255-3796 http://www.rainmakerssolutions.com/ |
| Part D Recovery Audit Contractor (Part D RAC) | |
|---|---|
| All 50 States | Part D RAC ACLR Strategic Business Solutions, LLC 38705 7 Mile Road, Suite 460 Livonia, MI, 48152-3975 Office: 1-866-722-6233 http://aclrsbs.com/ |
| Division of Plan Oversight & Accountability (DPOA) | |
|---|---|
| All 50 States | The Division of Plan Oversight and Accountability (DPOA) serves as the focal point for Fraud, Waste, and Abuse oversight of Medicare Advantage and Prescription Drug Plans. DPOA also performs oversight of the NBI MEDIC, O & E MEDIC and the Part D RAC. |
|
State Point of Contact Payment Error Rate Measurement (PERM) |
State Point of Contact Comprehensive Error Rate Testing (CERT) |
|
|---|---|---|
| All 50 States |
E-Mail: permproviders@cms.hhs.gov Website: http://www.cms.gov/perm PERM Statistical Contractor (SC) - The Lewin Group PERM Review Contractor (RC) - A+ Government Solutions |
E-Mail: cert@cms.hhs.gov Website: http://www.cms.gov/cert CERT Documentation Contrator (DC) - Livanta LLC. CERT Review Contractor (RC) - AdvanceMed Corp. CERT Statistical Contractor (SC) - The Lewin Group |
| Division of Data Analysis (DDA) | |
|---|---|
| All 50 States | To assure the integrity of Medicare Trust Fund dollars through program integrity and compliance efforts by actively seeking out suspected Medicare program vulnerabilities through a variety of methods, assessing scope and severity of risks, and working collaboratively within and outside CMS to develop, help implement, and monitor corrective actions. |
| National Benefit Integrity MEDIC (NBI MEDIC) | |
|---|---|
| All 50 States | National Benefit Integrity MEDIC Health Integrity, LLC 9240 Centreville Rd. Easton, MD 21601 Office: (410) 770-8583 Report Fraud, Waste or Abuse: 1-877-7SAFE-RX http://www.healthintegrity.org/ |
| Outreach & Education MEDIC (O&E MEDIC) | |
|---|---|
| All 50 States | Outreach & Education MEDIC Rainmakers Solutions 14319 Roxbury Lake Drive Glenelg, MD 21737 Office: 443-255-3796 http://www.rainmakerssolutions.com/ |
| Part D Recovery Audit Contractor (Part D RAC) | |
|---|---|
| All 50 States | Part D RAC ACLR Strategic Business Solutions, LLC 38705 7 Mile Road, Suite 460 Livonia, MI, 48152-3975 Office: 1-866-722-6233 http://aclrsbs.com/ |
| Division of Plan Oversight & Accountability (DPOA) | |
|---|---|
| All 50 States | The Division of Plan Oversight and Accountability (DPOA) serves as the focal point for Fraud, Waste, and Abuse oversight of Medicare Advantage and Prescription Drug Plans. DPOA also performs oversight of the NBI MEDIC, O & E MEDIC and the Part D RAC. |
Definition of Contractors
| CARRIER | A contractor that performs Medicare fee-for-service Part B claims administration services for physicians, non-physician practitioners, and suppliers, where the contract was implemented under statutory authority in effect prior to the enactment of Section 1874A of the Social Security Act. “By July 2013 all carriers and FIs will have transferred their claims administration responsibilities to the MAC in the relevant state.” |
| CERT | Comprehensive Error Rate Testing (CERT) program is to measure improper payments in the Medicare fee-for-service (FFS) program. The CERT program cannot be considered a measure of fraud. Since the CERT program uses random samples to select claims, reviewers are often unable to see provider billing patterns that indicate potential fraud when making payment determinations. CERT is designed to comply with the Improper Payments Elimination and Recovery Act of 2010. |
| DME MAC | Durable Medical Equipment - Medicare Administrative Contractor is a specialty MAC whose contract is awarded through competitive procedures and which provides for the processing of Medicare claims for durable medical equipment, prosthetics, orthotics, and supplies in keeping with 42 CFR 421.210. |
| FI | Fiscal Intermediary is a contractor that performs Medicare fee-for-service Part A claims administration services for institutional providers (such as hospitals, skilled nursing facilities, etc.) where the contract was implemented under statutory authority in effect prior to the enactment of Section 1874A of the Social Security Act. “By July 2013 all FIs and Carriers will have transferred their claims administration responsibilities to the MAC in the relevant state.” |
| HHH | Home Health and Hospice |
| IH | Indian Health |
| MAC | Medicare Administrative Contractor is a contractor that performs Medicare fee-for-service claims administration services that is awarded a contract through competitive procedures in keeping with Section 1874A of the Social Security Act. |
| PERM | The Payment Error Rate Measurement (PERM) program measures improper payments in Medicaid and CHIP and produces error rates for each program. The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of Medicaid and CHIP in the fiscal year (FY) under review. It is important to note the error rate is not a "fraud rate" but simply a measurement of payments made that did not meet statutory, regulatory or administrative requirements. |
| Recovery Auditor(s) | Recovery Auditors, are tasked with identifying and recovering Medicare overpayments and identifying underpayments. |
| RHHI | Regional Home Health and Hospice Intermediary |
| RRB | Railroad Retirement Board |
| ZPIC | The primary goal of the Zone Program Integrity Contractors (ZPICs) is to identify cases of suspected fraud, develop them thoroughly and in a timely manner, and take immediate action to ensure that Medicare Trust Fund monies are not inappropriately paid out and that any mistaken payments are recouped. There are seven ZPIC zones and the ZPICs for these zones are tasked with performing program integrity for Medicare Parts A, B, C, Durable Medical Equipment (DME), Home Health and Hospice (HH +H), and the Medicare-Medicaid data match program (Medi-Medi). |
| NBI MEDIC | The National Benefit Integrity (NBI) Medicare Drug Integrity Contractor (MEDIC) is a contractor responsible for monitoring all fraud, waste or abuse initiatives in the Medicare Advantage (Part C) and Prescription Drug Plan (Part D) benefits in all 50 states, the District of Columbia, and U.S. Territories. |
| PART D RAC | The Part D Recovery Audit Contractor (RAC) is a contractor that performs data analysis on Prescription Drug Events (PDE) submitted by Part D plan sponsors in order to detect improper payments. The RAC is paid a contingency fee for amounts recovered. |
| O&E MEDIC | The Outreach & Education MEDIC is a contractor that provides Medicare Advantage and Part D program integrity fraud, waste and abuse (FWA) education to stakeholders by developing comprehensive educational and training tools, relevant FWA news and industry resources, as well as facilitates FWA information sharing opportunities. |
- Page last Modified: 06/07/2012 8:57 AM
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