NHIC wins $148M Medicare claims payment contract with CMS

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The Centers for Medicare & Medicaid Services (CMS) has awarded the National Heritage Insurance Corporation (NHIC) a contract for the combined administration of Part A and Part B Medicare claims payment in Alaska, Idaho, Oregon and Washington. The contract is good for up to five years.

The Hingham, Mass.-based 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 four states, CMS said. 

The new Part A/Part B Medicare Administrative Contractor (A/B MAC) will take claims payment work now performed by two fiscal intermediaries and one carrier in the four states. The A/B MAC contract, which has an approximate value of $148 million over five years, will fulfill the requirements of the Medicare Modernization Act’s contracting reform provisions.

CMS said that 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 are rooted in CMS’ objectives for the MACs, including 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. 

As the A/B MAC contractor, NHIC will immediately begin implementation activities and will assume full responsibility for the claims processing work in its four-state jurisdiction by Dec. 31.