1. Organ- ization under contract to the state to process claims for a state Medicaid program. Also see A/B jurisdictions . 2. Insurance carrier that enters into an agreement with the Centers for Medicare and Medicaid Services (CMS). It receives and processes claims from physicians, hospital facilities, other suppliers of service, and durable medical equipment (DME) for Parts A and B of Medicare. Medicare contractors must have the provider customer service program (PCSP) in place to assist physicians and their staff in understanding and complying with Medicare’s operational processes, policies, and billing procedures. Formerly referred to as fiscal intermediary , Medicare carrier, fiscal agent, Medicare Part B carrier , or contractor . Also see Medicare Contracting Reform (MCR) and A/B jurisdiction .

Plan offered by a private insurance company that contracts with Medicare to provide beneficiaries with Medicare Part A and Part B benefits. Depending on where the patient lives, plans may or may not offer Medicare Part D prescription drug coverage. A Medicare Advantage Plan can be a health maintenance organization (HMO) plan, preferred provider organization (PPO) plan, special needs plan, or a private fee-for-service plan. In 2006 MA replaced the Medicare Plus (+) Choice program. Also referred to as Medicare Health Plans .

Program for CHAMPUS-eligible individuals younger than the age of 65 who qualify for both Medicare and CHAMPUS. Medicare is the primary payer and CHAMPUS is the secondary payer.

Online instruction handbook that the Centers for Medicare and Medicaid Services (CMS) makes available to Medicare carriers. It includes guidelines for processing and paying Medicare claims, preparing reimbursement forms, billing procedures, and Medicare regulations. This system has online, Internet-only manuals (IOM): National Coverage Determinations Manual, Publication 100, one-time notifications, and manual revision and update notices. This information is helpful to providers when dealing with Medicare contractors for issues such as researching information, claims processing, and appealing denials. Formerly found in Chapter II of the Medicare Carriers Manual, the Medicare Intermediary Manual and various provider manuals and program memorandums.

Health insurance available under Medicare Part A and Part B through the traditional fee-for-service payment system.

Document that the patient receives after the physician files an insurance claim for Part A services in the Original Medicare Plan. It lists the services the provider billed, the Medicare-approved amount, the Medicare payment, and the amount the patient must pay. The patient may also receive a Medicare Summary Notice (MSN) (formerly known as an Explanation of Medicare Benefits [EOMB] ). See also Medicare Summary Notice (MSN), remittance advice (RA) , and Explanation of Medicare Benefits (EOMB) .