Department of Justice to decide Medicare MAC contract protest

March 05, 2013
Area(s) of Interest: Access to Care Payor Contracting 

The Centers for Medicare & Medicaid Services (CMS) announced in September 2012 that Noridian has been named the new Medicare Administrative Contractor (MAC) for Medicare Parts A and B in Jurisdiction E (previously called Jurisdiction 1). Two protests were filed, challenging the award.

On January 18, 2013, the Government Accountability Office denied the two protests. As permitted by law, both protestors (Palmetto GBA and CGS) subsequently filed complaints with the U.S. Court of Federal Claims challenging the Jurisdiction E MAC contract award. The protests were filed on February 1, 2013. The Department of Justice is representing CMS before the court.

For at least the next several months, Medicare providers in Jurisdiction E (California, Hawaii, Nevada and the Pacific territories) will continue to file their Medicare claims with the incumbent Palmetto GBA.

CMS will notify affected Medicare providers about the situation, including any implementation dates, following the Court of Federal Claims review.

Jurisdiction E includes over 3.5 million Medicare fee-for-service beneficiaries, 500 Medicare hospitals and 86,500 physicians. MACs process Part A and Part B claims and perform other critical Medicare operational functions, including enrolling, educating and auditing Medicare providers.

Contact: CMA member service center, (800) 786-4262 or memberservice@cmadocs.org.


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