Each Durable Medical Equipment Administrative Contractor (DME MAC) is responsible for processing claims for specific states and territories. Claims must be submitted to the DME MAC that serves the state or territory where the Medicare beneficiary permanently resides. For example: A supplier is located in California. All DME MAC electronic claims (X12 837P and NCPDP D.0) as well as X12 276 transactions are collected by CEDI. CEDI also returns all DME MAC electronic front end acknowledgements/reports, X12 835 electronic remittance advices and X12 277 claim status response transactions. The premier global supplier of Mold Bases, Mold Components, Molding Supplies, Hot Runner & Controllers and Mold Technology with locations, operations, and strategic relationships in all corners of the globe, DME is determined to help our customers succeed in today’s ever changing economy. 5.ADVANCED DETERMINATION OF MEDICARE COVERAGE (ADMC) When Medicare is the primary payer, for all items requiring an ADMC (refer online to the DME MAC Jurisdiction D, Supplier Manual, Chapter 9). The ADMC determination must be submitted to the Quality Improvement Organization (QIO)- like vendor at the same time the prior authorization is submitted. A Durable Medical Equipment Medicare Administrative Contractor (DME MAC) is a private insurance company that has a contract with Medicare to process durable medical equipment (DME) claims. DME MACs follow Medicare national guidelines to decide on a local level what types of equipment should be covered on a case-by-case basis and how much.
Important Announcements
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Round 2021 of the DMEPOS Competitive Bidding Program begins on January 1, 2021, and extends through December 31, 2023. Round 2021 consolidates the competitive bidding areas (CBAs) that were included in Round 1 2017 and Round 2 Recompete. Round 2021 includes 130 CBAs.
On April 9, 2020, the non-invasive ventilators product category was removed from Round 2021 due to the novel COVID-19 pandemic.
On October 27, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the single payment amounts and began offering contracts for the off-the-shelf (OTS) back braces and OTS knee braces product categories. All other product categories were removed from Round 2021. Please see the CMS announcementfor additional information.
CMS is required by law to recompete contracts under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program at least once every three years. The contract periods for Round 1 2017, Round 2 Recompete, and the National Mail-Order Recompete expired on December 31, 2018.
People with Medicare
For more information, please visit the Medicare website at www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Dme Mac Jurisdiction D Supplier Manual
For information about the availability of auxiliary aids and services, please visit: www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html