Medicare administrative contractors (MACs) are private organizations that contract with the US Centers for Medicare & Medicaid Services (CMS) to administer the fee-for-service Medicare program within designated geographic or functional jurisdictions.. MACs process and pay claims under Medicare Part A and Part B or for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
Process and pay claims. Enroll providers and suppliers. Conduct medical review. Decide redeterminations at the first level of Medicare appeals. Provide customer service and provider education. Issue local coverage determinations.
MACs work with multiple functional contractors. In addition to the pre- and postpayment reviews conducted by the MACs, CMS employs limited prior authorization, targeted preclaim and prepayment reviews, and postpayment audits to reduce improper payments.
History Established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, MACs replaced the fiscal intermediaries and carriers that had administered Medicare claims since 1965.MMA § 911 et seq. SSA § 1874A; .
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