Provider/Supplier Inquiries to MACs Based on Eligibility

30.4 - Provider/Supplier Inquiries to MACs Based on Eligibility Responses (Rev. 1348, Issued: 10-05-07, Effective: 01-01-08, Implementation: 11-05-07) Institutional providers and/or suppliers may want to follow-up on information they receive, usually to contact the primary agency on file to bill under arrangement. The provider or supplier may determine the HHA’s A/B MAC (HHH) from the CMS Web site which has a list of A/B MACs (HHH) that process HH claims by State. The provider or supplier also may ask its own MAC through existing provider inquiry channels. That MAC will instruct the provider regarding which A/B MAC (HHH) that processes HH claims to contact to learn which HHA is involved. A/B MACs (HHH) that process HH claims may provide information on either the provider or A/B MAC (HHH) that these providers may request. Information released will be determined by each MAC, such as HHA name and address, but must be enough for the inquiring provider/supplier to contact either the primary HHA, if under that A/B MAC (HHH)’s jurisdiction, or another A/B MAC (HHH), if the provider number is attached to another A/B MAC (HHH). If an instance ever exists where a provider is an individual, such as a provider doing business using a Social Security Number as a tax identification number, information cannot be released, since it would violate the individual’s right to privacy.