Medicare Administrative Contractor (MAC) Transition and Outbound Health Insurance Portability and Accountability Act (HIPAA) Transactions

This article, informs all physicians, and providers who operate in multiple states under a single NPI that, beginning with the effective date of January 1, 2010, they will receive HIPAA outbound transactions separated by the appropriate contractor identifier (ID) number assigned to a MAC in files generated by Medicare’s Multi-Carrier Claims System (MCS) that process Part B claims.

Recently, CMS learned that, when there is a provider with a single NPI who provides services across states, Medicare-generated outbound transactions (835 – Health Care Claim Payment/Advice and 277 – Health Care Claim Status Notification) do not report the appropriate contractor ID in the envelope. The outbound transaction reported the first contractor ID for the MAC in the envelope when the transaction included multiple claims and status responses from a provider covering multiple states. This created an issue for clearinghouses trying to forward the correct 835/277 to the appropriate provider location. Beginning January 1, 2010, Medicare will generate separate professional outbound files by the appropriate contractor ID number assigned to a MAC.