Press Releases
CMS SELECTS NATIONAL HERITAGE INSURANCE CORPORATION
CMS SELECTS NATIONAL HERITAGE INSURANCE CORPORATION
TO ADMINISTER MEDICARE CLAIMS PAYMENT IN MAINE, MASSACHUSETTS, NEW HAMPSHIRE, RHODE ISLAND AND VERMONT
The Centers for Medicare & Medicaid Services (CMS) today announced that National Heritage Insurance Corporation (NHIC) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.
“With this award, CMS continues its progress in reengineering the way in which the government contracts for claims administration for the largest part of the Medicare program. CMS is seeking the best value, from a cost and technical perspective for this critical function,” said Acting CMS Administrator Kerry Weems. “This is another step toward improving services to beneficiaries and providers who are in the Medicare fee-for-service benefit plan.”
NHIC will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other health care practitioners in Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. The new Part A/Part B Medicare Administrative Contractor (A/B MAC) was selected using competitive procedures in accordance with federal procurement rules.
The new contractor will take claims payment work now performed by three fiscal intermediaries and two carriers in Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. The A/B MAC contract, which has an approximate value of $176 million over five years, will fulfill the requirements of the Medicare Modernization Act’s (MMA) contracting reform provisions.
Under the current system, fiscal intermediaries process claims for Medicare Part A providers, such as hospitals, skilled nursing facilities and other institutional providers. Carriers process claims for physicians, laboratories and other practitioners under Medicare Part B.
The contract for NHIC includes a base period and four one-year options and will provide NHIC with an opportunity to earn award fees based on its ability to meet or exceed the performance requirements set by CMS. These requirements are rooted in CMS’ key objectives for the MACs, including enhanced provider customer service, increased payment accuracy, improved provider education and training leading to correct claims submissions, and realized cost savings resulting from efficiencies and innovation. In accordance with the MMA, MAC contracts will be recompeted at least every five years.
As the A/B MAC contractor, NHIC will immediately begin implementation activities and will assume full responsibility for the claims processing work in its five-state jurisdiction no later than May 2009. NHIC will be reaching out to providers and state medical associations to provide education and information about the implementation. For more details, visit NHIC’s website at www.medicarenhic.com.
NHIC, the tenth new Part A/Part B MAC to be named by CMS, will be headquartered in Hingham, MA with other operational sites in Quincy, MA, Boston, MA and Biddeford, ME. By 2011, a total of 15 new Part A/Part B Medicare contractors will be operating in every state and the District of Columbia.
When contracting reform is fully implemented, all the fiscal intermediaries and carriers will be replaced by MACs responsible for both Part A and Part B claims processing. For beneficiaries and providers, the new structure will mean that they each will have a single point of contact with the Medicare program. When it becomes operational, the A/B MAC for Maine, Massachusetts, New Hampshire, Rhode Island and Vermontwill be the contact for all Medicare providers and physicians in the five states, while beneficiaries will pose their claims-related questions to a Beneficiary Contact Center.
CMS awarded the first A/B MAC contract in July 2006 to Noridian Administrative Services, LLC, headquartered in Fargo, N.D. The list of new contractors and the states they cover, along with other information, can be found at http://www.cms.hhs.gov/MedicareContractingReform/
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