New DME carriers named
WASHINGTON - HME providers in DMERC regions A and D will transition to new carriers come July 1, 2006.
CMS decided early last year to reorganize the DMERCs into two components, each overseen by a specialist contractor. One organization, the Medicare Affiliated Contractor or MAC, will handle a region's billing, customer service and other day-to-day operations. Each region will also have a Program Safeguard Contractor or PSC, overseen by a medical director, that handles fraud and abuse, medical review and crafts policy.
CMS announced the new PSCs last fall. In early January, it issued a release announcing the new MACs. They are:
- Region A, National Heritage Insurance Company replaces HealthNow. (Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont)
- Region B, AdminaStar Federal. (Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin)
- Region C, Palmetto GBA. (Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia and West Virginia)
- Region D, Noridian Administrative Services replaces Cigna. (Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington and Wyoming)
The DME MACs will immediately begin transition activities and will assume full responsibilities for the claims processing work currently performed by the DMERCs on July 1, 2006.
Each DME MAC contract includes a base period and four one-year options. The DME MACs will have the opportunity to earn award fees based on their ability to meet or exceed the performance requirements set by CMS.
CMS awarded the DME MAC contracts to companies who offered the best overall value to the government, in light of costs, technical qualifications, and other considerations, CMS state in its release.