General Information
The purpose of the Medicaid Administrative Claiming (MAC) program is to provide State affiliated public agencies such as Local Health Districts (LHD's) in Texas the opportunity to submit reimbursement claims for administrative activities that support the Medicaid program. In order for the cost to be allowable and reimbursable under Medicaid, the activities must be found to be necessary for the proper and efficient administration under the Texas Medicaid State Plan, and must adhere to applicable requirements as defined in State and Federal Law.
- Title XIX of the Social Security Act (the Act) authorizes federal grants to states for a proportion of expenditures for medical assistance under an approved Medicaid state plan, and for expenditures necessary for administration of the state plan. This joint federal-state financing of expenditures is described in section 1903(a) of the Act, which sets forth the rates of federal financing for.
- Visit Noridian's COVID-19 page for information and guidance related to COVID-19. Visit the CMS Current Emergencies page for information and updates related to COVID-19 and to access the Accelerated and Advanced Payments Fact Sheet. To support our providers, a COVID-19 Hotline has been established to help with COVID-19 related inquiries. The hotline number is: 866-575-4067.
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LHD's can be reimbursed for certain medical and health-related activities such as outreach services delivered to clients within the community, regardless of whether the client is Medicaid eligible or not, and without any impact on other similar services the patient may receive elsewhere. Outreach services may be provided to a client and/or the client's family and may include activities such as coordinating, referring, or assisting the client/family in accessing needed medical/health or mental care services.
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Revenue generated from MAC claims is dedicated to the provision of health services and may be used to enhance, improve and/or expand the level and quality of health/medical services provided to clients within the community. All MAC (Medicaid Administrative Claiming) expenditures which are subject to reimbursement are Title XIX funds. The MAC reimbursements payments received from Medicaid Administrative Claims CFDA #93.778 are subject to the Single Audit Act. Therefore, the funds should be included on the SEFA (Statement of Expenditures of Federal Awards) on each entity's audited financial statements. If the MAC award is identified as a major federal program, the entity's external auditor should perform work deemed necessary to reduce risk and report the funds appropriately in accordance with OMB Circular A-133. The auditor should research all other requirements to ensure that MAC funds are appropriately audited and reported.
Additional Information
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What is Medicaid Administrative Claiming for LHD's? (.pdf) (updated 08/17/2020)
Related Information
Guides / Manuals / Tutorials
MAC Financial Participation Guide (.pdf) - effective October 1, 2010
MAC Financial Guide (.pdf) - effective through September 30, 2010
MAC Video Tutorial - effective October 15, 2015
Time Study and MAC Guide (.pdf)
Notices
View a list of important notices regarding Medicaid Administrative Claiming for Local Health Districts.
Participation Documents
Contracting Information
The purpose of the Medicaid Administrative Claiming (MAC) program is to provide State affiliated public agencies in Texas the opportunity to submit reimbursement claims for administrative activities that support the Medicaid program. In order to participate in the MAC program, the LHD provider must be a public entity and enter into a MAC contract with the Texas Health & Human Services Commission (HHSC).
In addition to the contracting process, each LHD provider must also have an active Texas Provider Identifier (TPI) and/or National Provider Identifier (NPI), meet HHSC training requirements and participate in the Random Moment Time Study (RMTS), which includes the certification of the participant list and participation in the time study. To enroll as a Medicaid provider, please complete the Texas Medicaid fee-for-service provider enrollment form on the Texas Medicaid and Healthcare Partnership (TMHP) website:
An LHD provider that is interested in participating for this upcoming Federal Fiscal Year (FFY) should consider beginning the process as soon as possible, as it may take many months to complete all paperwork and training requirements.
Listing and links to all forms required for participation in the MAC program by LHD's.
Medicare Macs By State
Training
The link below contains information regarding the LHD training information. It is IMPORTANT to carefully read all the information provided so as to fully understand who must attend 'initial' training and who is eligible to take 'refresher' training.
Like any modern health care program, Medicare has many moving parts that allow it to run as smoothly as possible. Most of these parts work behind the scenes so that beneficiaries can focus on enjoying the benefits of their coverage. One of these moving parts is a Medicare Administrative Contractor (MAC). These often-unseen agents of Medicare can handle crucial services for beneficiaries when they need them, especially in Original Medicare.
Who are the MACs?
MACs were created by the Centers for Medicare & Medicaid Services (CMS) in 2003 by the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003. The goal of this change was to replace the Medicare Part A fiscal intermediaries (FIs) and Part B carriers with a single entity, the MAC. Specifically, MACs are private health care insurers that are awarded geographic coverage areas in which they can operate. These regions can, and often do, include multiple states.
Currently, there are two different types of MACs that are defined by the types of services they provide. In the United States, there are 12 Part A and B MACs that assist with Original Medicare. There are also four durable medical equipment (DME) MACs that operate independently of the A and B MACs. Together, these MACs assist roughly 68 percent of the Medicare beneficiary population.
What Does a MAC Do?
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Probably the most important job that MACs do for beneficiaries is handling the payment of Medicare’s fee-for-service (FFS) program. Without them, the reimbursement pipeline between Medicare and health care providers would break down. Why? Because MACs process the claims that the providers make. So, when your doctor submits their claim for payment to Medicare, it’s your region’s MAC that is receiving and processing the claim. MACs also help providers enroll in the FFS program so that they can receive payment from Medicare. They’re instrumental in the running and upkeep of the FFS program, running audits, and provider educational services.
One of the primary roles that MACs perform regards Medicare appeals. They act as a go-between for the beneficiary, the service provider, and CMS. If you disagree with a coverage decision from Medicare, the regional MAC will be involved with the process. For Original Medicare coverage appeals, they’ll be involved in the first step of appeals, which entails a redetermination of coverage. MACs are the company that processes these claims and makes a decision on the redetermination. They’re also involved in Part D coverage determinations, so if you disagree with your Part D coverage or costs, you’ll be working with a MAC again. The MAC will work with CMS to create local coverage determinations, when necessary, or follow national ones, when in place.
As mentioned above, there is also another type of MAC that handles DME claims. There are fewer DME MACs than Part A and B MACs, but they handle a larger region. They focus only on DME concerns, such as DME supplier claims for reimbursement and appeals.
How to Find a MAC
Finding your MAC region is pretty simple. If you’re curious, you can head over to CMS’ list of MAC resources by state. On the list, you can navigate to your state and find which Part A and B and DME MACs (broken down into jurisdictions) are assigned to your state. From there, you’ll also be linked to that MAC’s website. Additionally, you can find out more information about your jurisdictions on the Who Are MACs website. There, you’ll find a webpage for each jurisdiction that covers what states are included, which MAC is assigned to which jurisdiction, and how to get in contact with them. The pages also feature a Contract Award Information section that covers how a particular MAC was awarded their jurisdiction.
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In many ways, Medicare runs like a well-oiled machine. On the surface, it seems like one cohesive unit that helps you out, but under the surface, you’ll find many intricate, little parts that allow the overall system to run the way it does. The MACs are one of these unseen pieces that do a major task. Without them handling the FFS and the appeals, providers wouldn’t get paid and beneficiaries wouldn’t be able to argue their case if they disagree with their coverage situation. For three little letters, MACs can have a big impact!