The Centers for Medicare & Medicaid Services has awarded National Heritage Insurance Corporation a contract of up to five years for the administration of Part A and Part B Medicare claims payments in Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.
"With this award, CMS continues its progress in re-engineering the way in which the government contracts for claims administration for the largest part of the Medicare program," said Acting CMS Administrator Kerry Weems. "CMS is seeking the best value, from a cost and technical perspective, for this critical function."
The new Part A/B Medicare administrative Contractor (A/B MAC), NHIC, will take claims payment work now performed by three fiscal intermediaries. The contract, worth approximately $176 million, will fulfill the requirements of the Medicare Modernization Act's contracting reform provisions.
NHIC will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other healthcare practitioners in the five states.
"This is another step toward improving services to beneficiaries and providers who are in the Medicare fee-for-service benefit plan," Weems said.
The contract for NHIC includes a base period and four one-year options and will provide NHIC with an opportunity to earn award fees based on its ability to meet or exceed the performance requirements set by CMS.
These requirements include enhanced provider customer service, increased payment accuracy, improved provider education and training leading to correct claims submissions and realized cost savings resulting from efficiencies and innovation.
NHIC is the tenth new Part A/Part B MAC to be named by CMS and will be headquartered in Hingham, Mass., with other operational sites in Quincy, Mass., Boston and Biddeford, Maine. By 2011, 15 new Part A/Part B Medicare contractors will be operating in every state and the District of Columbia.
NHIC will immediately begin implementation activities and will assume full responsibility for the claims processing work in its five-state jurisdiction no later than May 2009.