What is a Medicare Carrier?
A Medicare carrier, or Medicare Administrative Contractor (MAC), serves as the primary point of contact for Medicare providers (physicians who accept Medicare for payment).
Contracted by the government, a Medicare carrier is typically an insurance company that oversees the administration and processing of both Medicare part A and part B policies. In addition, Medicare carriers also handle billing, claims appeals, identify billing errors, and answer any beneficiary inquires.
Medicare carriers vary by state and work with their area’s assigned providers (physicians) to ensure they meet enrollment requirements. It is the Medicare carrier’s responsibility to ensure the provider understands these conditions.
Although carriers are required to process claims according to the government’s regulations, as regional companies, they do have the authority to set local policies. A Medicare carrier, therefore, must review all Medicare claims and determine whether or not the claim qualifies for Medicare reimbursement.
Initially contracted on a one-year basis, Medicare carriers are reviewed annually to ensure they meet the guidelines set forth by the Center for Medicare and Medicaid Services (CMS). If deemed eligible, the carrier can then renew its contract for up to four additional years. To be eligible for renewal, a carrier must stay up to date on policy changes through regular, ongoing training and development.