Medicare Administrative Contractors

Medicare Administrative Contractors (MACs)

What is a MAC and What Do They Do?

A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic area or “jurisdiction” to regionally manage the policies and medical claims for Medicare Part A and Part B (A/B) Fee-For-Service (FFS) beneficiaries. The Centers for Medicare and Medicaid Services (CMS) relies on a network of MACs to serve as the primary operational contact between the Medicare FFS program and the health care providers enrolled in the program. MACs perform many activities including, but not limited to:

  • Processing Medicare FFS claims
  • Enrolling providers in the Medicare program
  • Educating providers about Medicare FFS billing requirements
  • Establishing local coverage determinations (LCD’s) and managing policy and payment related to reimbursement. 
  • Handling redetermination requests (1st level in the Medicare Appeals Process)
  • Utilizing data to target improper payment and vulnerabilities 
  • Performing audits/reviews of medical records and claims

Below is a listing of the Medicare A/B MACs by state. The ACA encourages all DCs to visit their MAC’s website to review the Local Coverage Determination (LCD) and any/all chiropractic-specific educational resources that have been developed to assist providers with proper coding, billing and documentation for services provided to Medicare beneficiaries.

Medicare Administrative Contractors (MACs) – By State

Cahaba GBA

CGS Medicare

First Coast Service Options

National Government Services

Noridian Healthcare Solutions

Novitas Solutions

Palmetto GBA 

  • Jurisdiction 11: North Carolina, South Carolina, Virginia and West Virginia

WPS Medicare