The CMS has awarded contracts to two companies that will help process Medicare claims and root out fraud.
CGS Administrators has been hired as the Medicare administrative contractor for Kentucky and Ohio, home to just under 2 million Medicare fee-for-service beneficiaries, according to the CMS.
The contract has one base year and four option years and is worth more than $246 million, according to an award notice.
Records indicate CGS' contract is being renewed. Under the agreement, the company will provide Medicare claims processing and payment services. It will also flag potentially fraudulent claims, enroll new providers into Medicare, conduct redeterminations on appeals of claims, operate a customer service program that educates providers about the Medicare program and respond to provider telephone and written inquiries.
A CGS spokesperson did not immediately return a request for comment.
The CMS has also renewed a contract with Noridian Healthcare Solutions to serve as durable medical equipment Medicare administrative contractor.
The scope of work is similar to a MAC, but a DME MAC focuses on claims related to medical equipment such as oxygen tanks, hospital beds, wheelchairs, walkers, power mobility devices, insulin pumps and breast pumps.
Noridian will specifically oversee equipment claims for a jurisdiction that includes several western and Midwestern states such as Alaska, Arizona, California, Missouri, Montana and Nebraska, among several others, as well a few U.S. territories that include Guam and the Northern Mariana Islands.
All told, Noridian's jurisdiction is home to more than 8.5 million Medicare fee-for-service beneficiaries, according to the CMS.
The contract is also good for one base year, with four option years and is worth up to $137 million.
“This re-award reflects NHS' exceptional Medicare claims administration performance, as well as our ability to implement innovations and enhancements to provide strong value throughout the contract,” NHS President and CEO Tom McGraw said in a statement.