Today, I am going back to basics by turning a spotlight on the Medicare Administrative Contractors (MACs).
The Centers for Medicare & Medicaid Services (CMS) contracts with so many companies, it can be easy to forget whether Novitas is a Recovery Audit Contractor (RAC) or whether CGS is a MAC – which is important, because each type of auditor is governed by diverse regulations and distinct policies. MACs, RACs, Targeted Probe-and-Educate (TPE), and Unified Program Integrity Contractors (UPICs) all have unique roles and responsibilities.
But again, today we are talking about MACs, which review:
If a MAC does anything else, call it out.
CGS Administrators, LLC, based out of Nashville, manages Medicare claims for hospitals and physicians in Kentucky and Ohio (J15) and also oversees durable medical equipment (DME) claims throughout much of the South and Midwest under its JB and JC regions. CGS handles redeterminations, provider education, and many TPE reviews.
First Coast Service Options, Inc. (FCSO) in Jacksonville, Florida administers Medicare Part A and B operations for Florida, Puerto Rico, and the U.S. Virgin Islands (JN). It processes claims, handles redeterminations, and manages home health and hospice programs for that region.
Novitas Solutions, Inc. (in Mechanicsburg, Pennsylvania) runs two jurisdictions: JL (Delaware, Washington, D.C., Maryland, New Jersey, and Pennsylvania) and JH (Arizona, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas). It manages inpatient and outpatient claims, redeterminations, and home health and hospice reviews across both regions.
National Government Services, Inc. (NGS) in Indianapolis, IN is responsible for Jurisdictions JK (Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont) and J6 (Illinois, Minnesota, Wisconsin). NGS processes claims, manages provider enrollment, and handles home health and hospice programs for both regions.
Noridian Healthcare Solutions, LLC in Fargo, North Dakota covers Jurisdiction JF (Arkansas, Arizona, Indiana, Montana, Nevada, Oregon, South Dakota, Utah, Wisconsin, and Wyoming) and operates as a DME MAC for JA and JD regions. Noridian is known for its extensive DME POS (Prosthetics, Orthotics, & Supplies) reviews and supplier oversight.
Palmetto GBA, LLC in Columbia, South Carolina oversees Jurisdictions JJ (Alabama, Georgia, and Tennessee) and JM (North Carolina, South Carolina, Virginia, and West Virginia). It also manages cost report acceptance, appeals, and the Home Health & Hospice MAC for its regions.
WPS Health Solutions in Madison, Wisconsin administers Medicare Part A/B and Home Health & Hospice claims in Jurisdiction 5 (Iowa, Kansas, Missouri, and Nebraska), focusing on provider education and redetermination services.
Clinical documentation integrity (CDI) professionals work in a variety of settings, and although I mostly focus on topics related to hospital inpatient billing, this week
Following the release of the Centers for Medicare & Medicaid Services (CMS) proposed Physician Fee Schedule (PFS) for 2026, outpatient evaluation and management (E&M) coding
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