Provider Assignment
Provider Assignment
On this page:
- Provider Nomination and the Geographic Assignment Rule
- Part A and Part B (A/B) and Home Health and Hospice (HH+H)
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
- Specialty Providers and Demonstrations
- Railroad Retirement Beneficiaries Entitled to Medicare
- Qualified Chains
- Out-of-Jurisdiction Providers (OJP)
Provider Nomination and the Geographic Assignment Rule
Section 911(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Public Law 108-173, repealed the provider nomination provisions formerly found in Section 1816 of the Title XVIII of the Social Security Act and replaced it with the Geographic Assignment Rule. Generally, a provider or supplier will be assigned to the Medicare Administrative Contractor (MAC) that covers the state where the provider or supplier is located. The Center for Medicare & Medicaid Services’ (CMS) has defined the following approach for assigning providers, physicians, and suppliers to MACs.
Part A/Part B (A/B) and Home Health and Hospice (HH+H) Rule
All A/B and HH+H providers will be assigned to the MAC contracted by CMS to administer A/B and HH+H claims for the geographic locale in which the provider is physically located. Learn more about the current A/B MAC jurisdictions and HH+H areas and view the corresponding maps at Who are the MACs.
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Rule
Each DMEPOS supplier submits claims to the DME MAC contracted by CMS to administer DMEPOS claims for the geographic locale in which the beneficiary resides permanently. Learn more about the current DME MAC jurisdictions and view the corresponding map at Who are the MACs.
Specialty Providers and Demonstrations Rule
Specialty providers and providers involved with certain demonstrations will submit claims to a specific MAC designated by CMS. Learn more about a specific A/B MAC or DME MAC and view the corresponding maps at Who are the MACs.
Railroad Retirement Beneficiaries Entitled to Medicare Rule
Physicians and other suppliers (except for DMEPOS suppliers) will continue to enroll with and bill the contractor designated by the Railroad Retirement Board for Part B services furnished to their beneficiaries. Each DMEPOS supplier will submit claims to the DME MAC contracted by CMS to administer DMEPOS claims for the geographic locale in which the beneficiary resides permanently. Learn more about the current DME MAC jurisdictions and view the corresponding map at Who are the MACs.
Qualified Chains Rule
The Geographic Assignment Rule states that generally, a provider or supplier will be assigned to the MAC that covers the state where the provider or supplier is located. However, it does provide an exception for qualified chains. A qualified chain home office may request that its hospitals and skilled nursing facilities be serviced by the A/B MAC that covers the state where the home office is located. A qualified chain home office may send an inquiry to: CMS Provider_MAC_Assignment_Inquiry@cms.hhs.gov
Out-of-Jurisdiction Providers (OJP) Rule
An OJP is a provider that is not currently assigned to an A/B MAC in accordance with the geographic assignment rule and the qualified chain exception. For example, a hospital not part of a qualified chain located in Maine, but currently assigned to the A/B MAC in Jurisdiction F would be an OJP.
Each A/B MAC will initially service some OJPs until CMS undertakes the final reassignment of all OJPs to their destination MACs based on the geographic assignment rule and its exceptions.
CMS has not set a timetable for moving OJP’s.
Page Last Modified:
09/10/2024 06:08 PM