Claim Filing Based On Beneficiary Address
Four durable medical equipment Medicare administrative contractors (DME MACs) process durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claims for designated states and territories. National Government Services is the Jurisdiction B DME MAC. National Government Services processes DMEPOS claims for the states of Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin. Unlike other Medicare claims, DMEPOS claim jurisdiction is based on the beneficiary’s address on file with the Social Security Administration. A DMEPOS claim should be sent to the DME MAC jurisdiction for the state in which the beneficiary resides.

A paper DMEPOS claim should be mailed to the DME MAC jurisdiction for the state in which the beneficiary resides. An electronic DMEPOS claim should be transmitted to the Common Electronic Data Interchange (CEDI) . Once the electronic claims have been accepted by the CEDI, the claims are transferred to the appropriate DME MAC for processing based on the beneficiary’s address listed on the electronic claim.

Disposition of Incorrectly Filed Claims

Paper Claims
Paper claims filed to the incorrect DME MAC for DMEPOS items will be returned to the supplier unprocessed. The supplier must file the claim to the appropriate DME MAC based on beneficiary residence.

Suppliers should review the DME MAC jurisdictions list to determine which DME MAC maintains authority over the claim.

Electronic Claims
All electronic claims should be transmitted to the CEDI , the claims are transferred to the appropriate DME MAC for processing based on the beneficiary’s address listed on the electronic claim. The supplier must have an electronic data interchange (EDI) enrollment form on file with the CEDI . If there is no EDI enrollment form on file with the CEDI , the claim will reject on the front end and claim(s) will not enter the Medicare processing system. If a supplier does not have an EDI enrollment form on file, they should obtain an EDI enrollment form from the CEDI Web site .

Examples
A beneficiary resides in Michigan and purchases DME in Ohio. The Ohio supplier sends the claim to the local Ohio carrier. The claim will be returned to the supplier as DME claims are not processed by the local Ohio carrier. The supplier must send the paper claim to the appropriate DME MAC (in this case, Jurisdiction B) or transmit the electronic claim to the CEDI.

If a Minnesota supplier files a paper claim for a beneficiary with a permanent residence in Wyoming to the Jurisdiction B DME MAC, the Jurisdiction B DME MAC will send the claim back to the supplier. The supplier must then send the claim to the appropriate DME MAC (Jurisdiction D).

If a Minnesota supplier files an electronic claim to the CEDI for a beneficiary whose permanent residence is in Wyoming, the CEDI will transfer the accepted claim to Jurisdiction D DME MAC for processing. If there is an EDI enrollment form on file, the Jurisdiction D DME MAC will accept the claim on the front end and adjudicate the claim. If an EDI enrollment form is not on file, the claim will reject on the front end. The supplier must complete and forward an EDI enrollment form to the CEDI and resubmit the electronic claim.

EDI enrollment forms are available on the CEDI Web site .

Durable Medical Equipment Medicare Administrative Contractors and Jurisdiction
The first of the full and open MAC competitions were held for the DME claims workloads. The Centers for Medicare & Medicaid Services (CMS) decided to start the Medicare Contracting Reform initiative with DME MACs because the workload of the four current durable medical equipment regional carriers (DMERCs) was stable and the risk of any significant program disruption to the provider and beneficiary communities would be minimal.

Jurisdiction A
The Jurisdiction A DME MAC contract was awarded to National Heritage Insurance Company (NHIC). The states included in DME MAC Jurisdiction A are: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.

Jurisdiction B
The Jurisdiction B DME MAC contract was awarded to National Government Services, Inc. The states included in DME MAC Jurisdiction B are: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin.

Jurisdiction C
The Jurisdiction C DME MAC contract was awarded to CIGNA Government Services. The states included in Jurisdiction C are: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia.

Jurisdiction D
The Jurisdiction D DME MAC contract was awarded to Noridian Administrative Services (NAS). The states included in DME MAC Jurisdiction D are: Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming.

DME MAC Jurisdiction Map

Resources
Current information on Medicare Administrative Contracts can be found on the CMS Web site .