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What is a Medicare Carrier?

A Medicare Carrier, also known as a Medicare Administrative Contractor is the major point of contact for Medicare providers. The federal government will seek contracts with a Medicare Carrier, who will be responsible for the administrative and processing aspects of Medicare Part A and Part B policies along with and answering queries and billing concerns of its plan members and providers.
Medicare carriers vary by state and work with their area’s assigned providers to ensure they meet enrollment requirements. To become a Medicare provider, applicants must submit an application, hold a valid medical license in their state, and comply with the U.S. government’s specified non-discrimination standards. In addition, the provider must agree to the Medicare program’s terms of reimbursement. It is the Medicare carrier’s responsibility to ensure the provider understands these conditions.
Carriers must also abide by local policies and not just those of the federal government. Thus, it is essential for a Medicare carrier to review all types of claims and determine their reimbursement qualification based on analytical reviews of claims.
Medicare Carriers are reviewed each year under CMS guidelines. If they are eligible, contracts will be renewed for another 4 years. For eligibility, a Medicare Carrier is required to stay up to date on all policy changes and provide constant training on any new federal and state regulations.
Humana Medicare, United Healthcare, Cigna Health Spring, Aetna and Coventry are some of the top Medicare providers we work with.
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