Intermediary Carrier Directory U.s. Department Of Health And Human ...
INTERMEDIARY-CARRIER
DIRECTORY
U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
Any inquiries regarding the content of this directory or changes to the information contained herein should be referred to the Centers
for Medicare & Medicaid Services, Office of Acquisition and Grants Management, Division of Medicare Contracts, 7500 Security
Boulevard - C2-21-15, Baltimore, Maryland 21244.
COMMUNICATING WITH INTERMEDIARIES AND CARRIERS
Medicare contracts cover the rights and obligations of Intermediaries, Carriers, and the Secretary of Health and Human Services.
Requests for action or information not specifically authorized by such contracts should not be made.
**************************************
PLEASE NOTE
Workweeks are from Monday through Friday, unless otherwise stated.
All hours of operation are from approximately 8:00 a.m. to 4:30 p.m.
ABBREVIATIONS
RHC - Rural Health Clinics
CHC - Community Health Centers
CSC - Christian Science Centers
HHA - Home Health Agencies
HL - Histocompatibility Labs (Independent)
OPA - Organ Procurement Agencies (Independent)
PE - Parenteral/Enteral
DME - Durable Medical Equipment
LPIC-Limited Purpose Insurance Company
RRB - Rail Road Retirement Board (South Carolina)
EFFECTIVE DATE: January 2007
INTERMEDIARY AND CARRIER DIRECTORY
Table of Contents
SECTION I
PART A INTERMEDIARIES AND PART B CARRIERS BY STATE ......................................................... 4
SECTION II
PART A INTERMEDIARIES AND PART B CARRIERS ......................................................................... 15
BLUE CROSS AND BLUE SHIELD ASSOCIATION......................................................................................15
BLUE CROSS AND BLUE SHIELD OF ALABAMA ......................................................................................15
ARKANSAS BLUE CROSS AND BLUE SHIELD...........................................................................................18
FIRST COAST SERVICE OPTIONS, INC. .......................................................................................................20
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. ..............................................................................21
ANTHEM INSURANCE COMPANIES INC ....................................................................................................22
ADMINASTAR FEDERAL INC........................................................................................................................23
BLUE CROSS AND BLUE SHIELD OF KANSAS, INC. ................................................................................23
ANTHEM HEALTHPLANS OF MAINE INC...................................................................................................24
BLUE CROSS AND BLUE SHIELD OF MISSISSIPPI ....................................................................................25
BLUE CROSS AND BLUE SHIELD OF NEBRASKA.....................................................................................26
ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.............................................................................26
EMPIRE HEALTHCHOICE ASSURANCE, INC. ............................................................................................27
HEALTHNOW NEW YORK INC.. ...................................................................................................................28
NORIDIAN MUTUAL INSURANCE COMPANY...........................................................................................29
GROUP HEALTH SERVICE OF OKLAHOMA, INC. .....................................................................................30
HIGHMARK INC. ..............................................................................................................................................31
TRIPLE-S, INC. ..................................................................................................................................................32
PALMETTO GBA, LLC.....................................................................................................................................33
BLUE CROSS AND BLUE SHIELD OF TENNESSEE....................................................................................35
TRAILBLAZER HEALTH ENTERPRISES, LLC.............................................................................................35
UNITED GOVERNMENT SERVICES, LLC ....................................................................................................37
INTERMEDIARY AND CARRIER DIRECTORY
2
Table of Contents (continued)
SECTION III
COMMERCIAL AND INDEPENDENTS - PARTS A & B
COOPERATIVA DE SEGUROS DE VIDA DE PUERTO RICO .....................................................................38
CONNECTICUT GENERAL LIFE INSURANCE COMPANY........................................................................39
GROUP HEALTH INCORPORATED ...............................................................................................................40
MUTUAL OF OMAHA INSURANCE COMPANY .........................................................................................41
NATIONAL HERITAGE INSURANCE COMPANY .......................................................................................43
WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION ........................................................45
SECTION IV
REGIONAL HOME HEALTH INTERMEDIARIES .........................................................................................46
DURABLE MEDICAL EQUIPMENT MEDICARE ADMINISTRATIVE CONTRACTOR ...........................48
COMMON WORKING FILE HOST CONTRACTORS....................................................................................51
RURAL HEALTH CLINICS ..............................................................................................................................52
SECTION V
A/B MAC’s
NORIDIAN ADMINISTRATIVE SERVICES, LLC .........................................................................................29
3
SECTION I
PART A INTERMEDIARIES AND PART B CARRIERS BY STATE
REGIONAL
OFFICE
Alabama
Atlanta
Part A - Blue Cross and Blue Shield of Alabama
Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Alabama
RHHI – Palmetto GBA, LLC
DMERC– Palmetto GBA, LLC
Alaska
Seattle
Part A - Noridian Mutual Insurance Company
Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI – United Government Services, LLC
DME MAC – Noridian Mutual Insurance Company
American Samoa
Part A –United Government Services, LLC
Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI – United Government Services, LLC
DME MAC – Noridian Mutual Insurance Company
Arizona
San
Francisco
Part A/B MAC – Noridian Administrative Services, LLC
Mutual of Omaha Insurance Company
RHHI – United Government Services, LLC
DME MAC – Noridian Mutual Insurance Company
Arkansas
Dallas
Part A - Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company
Mutual of Omaha Insurance Company
Part B - Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company
RHHI – Palmetto GBA, LLC
DMERC – Palmetto GBA, LLC
4
SECTION I - PART A INTERMEDIARY AND PART B CARRIER BY STATE
REGIONAL
OFFICE
California
San
Francisco
Part A – United Government Services, LLC
Mutual of Omaha Insurance Company
Part B - National Heritage Insurance Company
RHHI – United Government Services, LLC
DME MAC – Noridian Mutual Insurance Company
Colorado
Denver
Part A- TrailBlazer Health Enterprises, LLC
Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI - Blue Cross and Blue Shield of Alabama
DMERC – Palmetto GBA, LLC
Connecticut
Boston
Part A - Empire HealthChoice Assurance, Inc.
Mutual of Omaha Insurance Company
Part B - First Coast Service Options, Inc.
RHHI - Anthem Health Plans of Maine Inc.
DME MAC – National Heritage Insurance Company
Delaware
Philadelphia
Part A - Empire HealthChoice Assurance, Inc.
Mutual of Omaha Insurance Company
Part B -TrailBlazer Health Enterprises, LLC
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC- National Heritage Insurance Company
District of Columbia
Philadelphia
Part A –Highmark Inc.
Mutual of Omaha Insurance Company
Part B - TrailBlazer Health Enterprises, LLC
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC – National Heritage Insurance Company
5
SECTION I - PART A INTERMEDIARY AND PART B CARRIER BY STATE
REGIONAL
OFFICE
Florida
Philadelphia
Part A - First Coast Service Options
Mutual of Omaha Insurance Company
Part B - First Coast Service Options
RHHI – Palmetto GBA, LLC
DMERC – Palmetto GBA, LLC
Georgia
Atlanta
Part A - Blue Cross and Blue Shield of Georgia, Inc.
Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Alabama
RHHI – Palmetto GBA, LLC
DMERC – Palmetto GBA, LLC
Guam
San
Francisco
Part A – United Government Services, LLC
Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI -
DME MAC – Noridian Mutual Insurance Company
Hawaii
San Francisco
Part A – United Government Services, LLC
Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI – United Government Services, LLC
DME MAC – Noridian Mutual Insurance Company
Idaho
Seattle
Part A – Noridian Mutual Insurance Company
Mutual of Omaha Insurance Company
Part B - Connecticut General Life Insurance Company
RHHI – United Government Services, LLC
DME MAC – Noridian Mutual Insurance Company
Illinois
Chicago
Part A - Anthem Insurance Companies, Inc.
Mutual of Omaha Insurance Company
Part B - Wisconsin Physicians Service
RHHI – Palmetto GBA, LLC
DMERC – Palmetto GBA, LLC
6
SECTION I - PART A INTERMEDIARY AND PART B CARRIER BY STATE
REGIONAL
OFFICE
Indiana
Chicago
Part A - Anthem Insurance Companies, Inc.
Mutual of Omaha Insurance Company
Part B - AdminaStar Federal, Inc.
RHHI – Palmetto GBA, LLC
DME MAC - AdminaStar Federal Inc.
Iowa
Kansas
City
Part A - Blue Cross and Blue Shield of Alabama
Mutual of Omaha Insurance Company
Part B -Noridian Mutual Insurance Company
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC – Noridian Mutual Insurance Company
Kansas
Kansas City
Part A - Blue Cross and Blue Shield of Kansas, Inc.
Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Kansas, Inc.
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC – Noridian Mutual Insurance Company
Kentucky
Atlanta
Part A - Anthem Insurance Companies, Inc.
Mutual of Omaha Insurance Company
Part B - AdminaStar Federal, Inc.
RHHI – Palmetto GBA, LLC
DME MAC – AdminaStar Federal, Inc.
Louisiana
Dallas
Part A - Blue Cross and Blue Shield of Mississippi
Mutual of Omaha Insurance Company
Part B - Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company
RHHI – Palmetto GBA, LLC
DMERC – Palmetto GBA, LLC
7
SECTION I - PART A INTERMEDIARY AND PART B CARRIER BY STATE
REGIONAL
OFFICE
Maine
Boston
Part A - Anthem Health Plans of Maine Inc.
Mutual of Omaha Insurance Company
Part B - National Heritage Insurance Company
RHHI - Anthem Health Plans of Maine Inc.
DME MAC – National Heritage Insurance Company
Maryland
Philadelphia
Part A - Highmark Inc.
Mutual of Omaha Insurance Company
Part B -TrailBlazer Health Enterprises, LLC
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC – National Heritage Insurance Company
Massachusetts
Boston
Part A - Anthem Health Plans of Maine Inc.
Mutual of Omaha Insurance Company
Part B - National Heritage Insurance Company
RHHI - Anthem Health Plans of Maine Inc.
DME MAC – National Heritage Insurance Company
Michigan
Chicago
Part A – United Government Services, LLC
Mutual of Omaha Insurance Company
Part B - Wisconsin Physicians Service
RHHI – Palmetto GBA, LLC
DME MAC - AdminaStar Federal Inc.
Minnesota
Chicago
Part A - Noridian Mutual Insurance Company
Mutual of Omaha Insurance Company
Part B - Wisconsin Physicians Service
RHHI - United Government Services, LLC
DME MAC - AdminaStar Federal Inc.
8
SECTION I - PART A INTERMEDIARY AND PART B CARRIER BY STATE
REGIONAL
OFFICE
Mississippi
Atlanta
Part A - Blue Cross and Blue Shield of Mississippi
Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Alabama
RHHI – Palmetto GBA, LLC
DMERC – Palmetto GBA, LLC
Missouri
Kansas
City
Part A - Blue Cross and Blue Shield of Mississippi
Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Kansas, Inc. (Western Missouri)
Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company (Eastern Missouri)
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC – Noridian Mutual Insurance Company
Montana
Denver
Part A/B MAC- Noridian Administrative Services, LLC
Mutual of Omaha Insurance Company
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC– Noridian Mutual Insurance Company
Nebraska
Kansas
City
Part A - Blue Cross and Blue Shield of Nebraska
Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Kansas, Inc.
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC – Noridian Mutual Insurance Company
Nevada
San Francisco
Part A – United Government Services, LLC
Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI – United Government Services, LLC
DME MAC – Noridian Mutual Insurance Company
9
SECTION I - PART A INTERMEDIARY AND PART B CARRIER BY STATE
REGIONAL
OFFICE
New Hampshire
Boston/San
Francisco
Part A - Anthem Health Plans of New Hampshire, Inc.
Mutual of Omaha Insurance Company
Part B - National Heritage Insurance Company
RHHI - Anthem Health Plans of New Hampshire, Inc.
DME MAC – National Heritage Insurance Company
New Jersey
New York
Part A -Blue Cross Blue Shield of Tennessee
Mutual of Omaha Insurance Company
Part B - Empire HealthChoice, Inc.
RHHI – United Government Services, LLC
DME MAC – National Heritage Insurance Company
New Mexico
Dallas
Part A -TrailBlazer Health Enterprises, LLC
Mutual of Omaha Insurance Company
Part B - Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company
RHHI – Palmetto GBA, LLC
DMERC – Palmetto GBA, LLC
New York
New York
Part A - Empire HealthChoice Assurance, Inc.
Part B - HealthNow New York, Inc.
Empire HealthChoice Assurance,Inc.
Group Health Incorporated
RHHI – United Government Services, LLC
DME MAC – National Heritage Insurance Company
North Carolina
Atlanta
Part A - Blue Cross and Blue Shield of South Carolina
Mutual of Omaha Insurance Company
Part B - Connecticut General Life Insurance Company
RHHI – Palmetto GBA, LLC
DMERC – Palmetto GBA, LLC
REGIONAL
10
SECTION I - PART A INTERMEDIARY AND PART B CARRIER BY STATE
OFFICE
North Dakota
Denver
Part A/B MAC - Noridian Administrative Services, LLC
Mutual of Omaha Insurance Company
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC – Noridian Mutual Insurance Company
Northern Marianna Islands
San Francisco
Part A – United Government Services, LLC
Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI – United Government Services, LLC
DME MAC– Noridian Mutual Insurance Company
Ohio
Chicago
Part A - Anthem Insurance Companies, Inc.
Mutual of Omaha Insurance Company
Part B – Palmetto GBA, LLC
RHHI – Palmetto GBA, LLC
DME MAC- AdminaStar Federal Inc.
Oklahoma
Dallas
Part A - Group Health Service of Oklahoma, Inc.
Mutual of Omaha Insurance Company
Part B - Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company
RHHI – Palmetto GBA, LLC
DMERC – Palmetto GBA, LLC
Oregon
Seattle
Part A – Noridian Mutual Insurance Comany
Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI – United Government Services, LLC
DME MAC – Noridian Mutual Insurance Company
11
SECTION I - PART A INTERMEDIARY AND PART B CARRIER BY STATE
REGIONAL
OFFICE
Pennsylvania
Philadelphia
Part A - Highmark Inc.
Mutual of Omaha Insurance Company
Part B - Highmark Inc.
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC – National Heritage Insurance Company
Puerto Rico
New York
Part A - Cooperative de Seguros de Vida de Puerto Rico
Mutual of Omaha Insurance Company
Part B - Triple-S, Inc,
RHHI – United Government Services, LLC
DMERC – Palmetto GBA, LLC
Rhode Island
Boston
Part A – Arkansas Blue Cross and Blue Shield, A Mutual Ins. Company
Mutual of Omaha Insurance Company
Part B – Arkansas Blue Cross and Blue Shield, A Mutual Ins. Company
RHHI - Anthem Health Plans of Maine Inc.
DME MAC – National Heritage Insurance Company
South Carolina
Atlanta
Part A – Palmetto GBA, LLC
Mutual of Omaha Insurance Company
Part B – Palmetto GBA, LLC
RHHI – Palmetto GBA, LLC
DMERC– Palmetto GBA, LLC
South Dakota
Denver
Part A - Blue Cross and Blue Shield of Alabama
Mutual of Omaha Insurance Company
Part A/B MAC - Noridian Administrative Services, LLC
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC – Noridian Mutual Insurance Company
12
SECTION I - PART A INTERMEDIARY AND PART B CARRIER BY STATE
REGIONAL
OFFICE
Tennessee
Atlanta
Part A - Blue Cross and Blue Shield of Tennessee
Mutual of Omaha Insurance Company
Part B -Connecticut General Life Insurance Company
RHHI – Palmetto GBA, LLC
DMERC – Palmetto GBA, LLC
Texas
Dallas
Part A - TrailBlazer Health Enterprises, LLC
Mutual of Omaha Insurance Company
Part B - TrailBlazer Health Enterprises, LLC
RHHI – Palmetto GBA, LLC
DMERC – Palmetto GBA, LLC
U.S. Virgin Islands
New York
Part A - Cooperative de Seguros de Vida de Puerto Rico
Mutual of Omaha Insurance Company
Part B - Triple-S, Inc.
RHHI – United Government Services, LLC
DMERC – Palmetto GBA, LLC
Utah
Denver
Part A/B MAC – Noridian Administrative Services, LLC
Mutual of Omaha Insurance Company
Part B – Noridian Mutual Insurance Company
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC – Noridian Mutual Insurance Company
Vermont
Boston/
Part A - Anthem Health Plans of New Hampshire, Inc.
San Francisco
Mutual of Omaha Insurance Company
Part B - National Heritage Insurance Company
RHHI - Anthem Health Plans of Maine Inc.
DME MAC – National Heritage Insurance Company
13
SECTION I - PART A INTERMEDIARY AND PART B CARRIER BY STATE
REGIONAL
OFFICE
Virginia
Philadelphia
Part A –United Government Services, LLC
Mutual of Omaha Insurance Company
Part B - TrailBlazer Health Enterprises, LLC
RHHI -Blue Cross and Blue Shield of Alabama
DMERC – Palmetto GBA, LLC
Washington
Seattle
Part A - Noridian Mutual Insurance Company
Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI – United Government Services, LLC
DME MAC – Noridian Mutual Insurance Company
West Virginia
Philadelphia
Part A –United Government Services, LLC
Mutual of Omaha Insurance Company
Part B – Blue Cross Blue Shield of South Carolina
RHHI - Blue Cross and Blue Shield of Alabama
DMERC – Palmetto GBA, LLC
Wisconsin
Chicago
Part A – United Government Services, LLC
Mutual of Omaha Insurance Company
Part B - Wisconsin Physicians Service
RHHI – United Government Services, LLC
DME MAC – AdminaStar Federal Inc.
Wyoming
Denver
Part A/B MAC – Noridian Administrative Services, LLC
Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI - Blue Cross and Blue Shield of Alabama
DME MAC – Noridian Mutual Insurance Company
14
SECTION II
PART A INTERMEDIARIES AND PART B CARRIERS
BLUE CROSS AND BLUE SHIELD ASSOCIATION
225 North Michigan Avenue
Chicago, Illinois 60601-7680
PHONE: 312-297-6000
PART A - AGREEMENT NO. HCFA 87-001-1
FAX: 312-297-6609
Scott P. Serota
Wilson C. Leong, Esq. CPA
President and Chief
Executive Director
Executive Officer
Prime Contract
PHONE: 312-297-6010
PHONE: 312-297-5869
ALABAMA PART A PROVIDER SERVICE AREA: State of Alabama, Iowa and South Dakota (Special Claims: HHA)
PART B JURISDICTION: State of Alabama, State of Georgia, and Mississippi
BLUE CROSS AND BLUE SHIELD OF ALABAMA
P.O. Box 830139
Birmingham, Alabama 35283-0139
(d.b.a. Cahaba Government Benefit Administrators)
Overnight Packages Only
Cahaba Government Benefit Administrators
Alabama Medicare Claims Administration
450 Riverchase Parkway East
Birmingham, Alabama 35244
PHONE: 205-220-4835
PART A - AGREEMENT NO. HCFA 87-001-1.1
FAX: 205-220-0928
PART B - CONTRACT NO. HCFA 87-003-2
website:www.cahabagba.com
Lynda Northcutt
Brandon
Ward
President
Director, Cahaba Operations
Cahaba Government Benefit
Cahaba Government Benefit
Administrators, LLC
Administrators, LLC
PHONE: 205-220-4835
450 Riverchase Parkway East
Email: lnorthcutt@bcbsal.org
Birmingham, Alabama 35244
Phone: 205-220-1381
E-Mail: bward@cahabagba.com
15
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
BLUE CROSS AND BLUE SHIELD OF ALABAMA CONTINUED
Leigh Forman
Susan
Pretnar
John W. Cook, Jr.
Executive Director
Executive Director, Part A & RHHI
Executive Director, Quality
Part B Claims
Claims
Cahaba Government Benefit Admihistrators
Cahaba Government Benfit
Cahaba Government Benefit
PHONE: 601-977-5850
Administratos
Administrators
E-mail: jwcook@cahagagba.com
PHONE: 912-921-3087
Phone: 515-471-7302
E-Mail –
E-mail: spretnar@cahabagba.com
lforman@cahabagba.com
David Brown
Jim
Hill
Executive Director
Executive Director
Cahaba Resource Center
Operations Support
Cahaba Government Benefit
Cahaba Government Benefit
Administrators
Administrators
Phone: 205-220-1398
Phone: 205-220-1437
E-mail: dbrown@cahabagba.com
E-mail: jhill@cahabagba.com
ALABAMA OFFICE – Medicare & Intermediary & Carrier
450 Riverchase Parkway East
Birmingham, AL 35244
P.O. Box 830139
Birmingham, AL 35283-0139
FAX: 205-220-0928
Email address: almedicare@bcbal.org
Web site: www.cahabaga.com
Beneficiary Customer Service - 1-800-Medicare (1-800-633-4227)
Provider Line - 1-866-539-5598
GEORGIA OFFICE - Medicare Carrier
MISSISSIPPI OFFICIE
775 Woodlands Parkway
12052 Midddleground Road, Suite A
Ridgeland, MS 39157-5212
Savannah, GA 31419-1699
P.O. Box 22545
P.O. Box 3018
Jackson, MS 39225-2545
Savannah, GA 31402
FAX: 601-956-2738
FAX:912-921-4635
Email address: msmedicare@cahabag.com
Email address:gamedicare@cahabagba.com
Beneficiary Customer Service – 1-800-Medicare (1-800-633-
Beneficiary Customer Service 1-800-Medicare (1-800-633-
4227)
4227)
Provider Line - 1-866-419-9454
Provider Line 1-912-927-0934
16
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
Blue Cross and Blue Shield Continued
MIDWEST OFFICE – INTERMEDIARY & RHHI
400 W. Court Avenue, Station 158
Des Moines, IA 50309-2017
Fax: 515-471-7222
Email address: iamedicare@cahabagba.com
Beneficiary Line – 1800-Medicare (1-800-633-4227)
Home Health: 1-877-299-4500
Hospice: 1-866-539-5592
Hospital & Other: 1-877-567-3092
MSP: 515-471-7400
ALASKA
PART A PROVIDER SERVICE AREA - See Noridian Mutual Insurance Company (North Dakota)
PART B JURISDICTION - See Noridian Mutual Insurance Company (North Dakota)
ARIZONA
PART A PROVIDER SERVICE AREA: See Part A/B MAC Noridian Administrative Services
PART B JURISDICTION - See Noridian Mutual Insurance Company (North Dakota)
17
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
ARKANSAS PART A PROVIDER SERVICE AREA: States of Arkansas and Rhode Island
PART B JURISDICTION: States of Arkansas , Louisiana, Oklahoma, New Mexico, Eastern Missouri and
Rhode Island
ARKANSAS BLUE CROSS AND BLUE SHIELD
A MUTUAL INSURANCE COMPANY
(d.b.a. Pinnacle Business Solutions, Inc. (PBSI)
ABCBS STREET ADDRESS:
601 South Gaines Street
Little Rock, Arkansas 72203
MAILING ADDRESS:
P.O. Box 1418
Little Rock, Arkansas 72201
Pinnacle Medicare Services
515 West Pershing Boulevard
North Little Rock, Arkansas 72114-2147
PHONE: 501-210-9000
PART A - AGREEMENT NO. HCFA 87-001-1.3
FAX: 501-210-9153
PART B - CONTRACT NO . HCFA-87-004-2
INTERNET:tlwhite@pinnacleBSI.com
Web Sites:
AR – www.arkmedicare.com
Medicare Beneficiary Toll-Free Phone – 1-800-MEDICARE
Medicare AR Part A Provider Toll-Free Phone – 1-866-0527
Medicare AR Part B Provider Toll-Free Phone – 1-866-345-0274
LA- www.lamedicare.com
Medicare LA Part B Provider Toll-Free Phone – 1-866-567-8419
OK – www.oknmmedicare.com
NM- www.oknmmedicare.com
Medicare OK/NM Part B Provider Toll-Free Phone – 1-866-280-6520
MO – www.momedicarecom
Medicare MO Part B Provider Toll-Free Phone – 1-866-736-0799
RI – www.rimedicare.com
Medicare RI Part A Provider Toll-Free Phone – 1-866-339-3714
Medicare RI Part B Provider Toll-Free Phone – 1-866-801-5304
Pinnacle Medicare Services
Pinnacle Medicare Services
Pinnacle Medicare Services
Pinnacle Medicare Services
Dennis Robertson
Ms. Reggie Favors
Charles Clem
Dan Bloodworth
President & CEO
Executive Vice President &
Executive Vice President &
Senior Vice President
PHONE: 501-210-9035
COO
COO
CFO
PHONE: 501-210-9036
PHONE: 501-210-9076
PHONE: 501-210-9105
Pinnacle Medicare Services
Pinnacle Medicare Services
Theresa Milligan
Pinnacle Medicare Services
Charlene Kane
Chief Internal Controls &
Janice Fenton
Chief Compliance Officer
Security Officer
Chief Legal Officer
PHONE: 501-210-9162
PHONE: 501-210-9078
PHONE: 501-21-9040
18
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
Arkansas Blue Cross & Blue Shield
continued
Louisiana Part B Operations
Rhode Island Part A & B Operations
Bon Carre Business Center
86 Weybossett
7159 Florida Boulevard
Providence, RI 02903-2800
Baton Rouge, LA 70806
Joan Costello
Margie Slaughter
Director, RI Operations
Director, Louisiana Part B Operations
Phone: 410-276-5830
Phone: 225-231-2220
Part A Provider: 1-866-339-3714
Provider:1-877-567-7204
Part A Beneficiary: 1-800-662-5170
Beneficiary:1-800-392-3070
Part B Provider: 1-866-801-5304
Part B Beneficiary: 1-800-662-5170
Oklahoma/New Mexico Part B
Eastern Missouri Part B Satellite
Operations
Office
701 NW 63rd
12755 Olive Street
Oklahoma City, OK 73116
St. Louis, Missouri 63141
PHONE:314-212-1705
Curtis Blair
Director Oklahoma/New Mexico
Provider:1-866-539-5599
Operations
Beneficiary:1-800-392-3070
Phone: 405-841-6738
Lanny Day
Director, Congressional Liaison**
Phone: 405-841-67398
**FOR ALL LOCATIONS
Provider:OK/NM:1-877-567-9230
Beneficiairy:OK:1-800-522-9079
Beneficiary:NM:1-800-423-2925
19
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
CALIFORNIA
PART A PROVIDER SERVICE AREA: See United Government Services, LLC
PART B JURISDICTION: See National Heritage Insurance Company
COLORADO
PART A PROVIDER SERVICE AREA - See TrailBlazer Health Enterprises (Texas) and Blue Cross and
Blue Shield of South Carolina (HHA only).
PART B JURISDICTION - See Noridian Mutual Insurance Company (North Dakota)
CONNECTICUT
PART A PROVIDER SERVICE AREA: See New York, Empire HealthChoice, Inc.
PART B JURISDICTION - See Florida – First Coast Service Options, Inc.
DELAWARE PART A PROVIDER SERVICE AREA: See New York, Empire HealthChoice, Inc.
PART B JURISDICTION - See (Texas) TrailBlazer Health Enterprises, LLC
DISTRICT OF COLUMBIA
PART A PROVIDER SERVICE AREA - See Pennsylvania, Highmark Inc.
PART B JURISDICTION - See (Texas) TrailBlazer Health Enterprises, LLC
FLORIDA
PART A PROVIDER SERVICE AREA: State of Florida
PART B JURISDICTION: State of Florida, and Connecticut
FIRST COAST SERVICE OPTIONS, INC.
532 Riverside Avenue
Jacksonville, Florida 32202
PART A Mailing Address(Claims & Correspondence)
PART B Mailing Address(Claims)
P.O. Box 2711
P.O. Box 2525
Jacksonville, Florida 32231-0021
Jacksonville, Florida 32231-0048
P.O. Box 2360 (Correspondence)
Jacksonville, FL 32231-0048
PART A - AGREEMENT NO. HCFA 87-001-1.10
PART B - CONTRACT NO. HCFA-87-009-2
PHONE:904-791-6111
MEDICARE A & B BENEFICIARY-TOLL-FREE: 1-800-MEDICARE
MEDICARE B PROVIDER-TOLL-FREE: 1-877-847-4992
MEDICARE B PROVIDER-CSR CALLS: 1-866-454-9007
MEDICARE A PROVIDER ONLY: 1-877-602-8816
INTERNET:Providers - floridamedicare.com
Beneficiaries - medicarefla.com
First Coast Services
First Coast Service Options,
Programs Safeguards A/B
Programs Management A/B
Options, Inc.
Inc.
Lamar James
Curtis Lord
Sandy L. Coston
Dr. James J. Corcoran Jr.
Vice President
CEO
President & COO
Medical Director
Medicare Operations
532 Riverside Avenue
PHONE: 904-791-8409
Phone: 904-791-8211
Phone: 904-791-8358
Jacksonville, FL 32202
PHONE: 904-791-8090
Dr. Eugene Winter, MD
Phone: 904-791-8182
20
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
FIRST COAST SERVICE OPTIONS, INC. (CONNECTICUT - PART B ONLY)
321 Research Parkway
Meriden, CT 06540-7148
BENEFICIARY - TOLL FREE - 1-800-MEDICARE
PROVIDER - TOL FREE - 1-866-419-9455
CUSTOMER SERVICE - 203-639-3000
Mailing Address (Claims and Correspondence)
P.O. Box 9000
Meriden, CT 05640
Program Management B
Programs Safeguards A/B
Lamar James
Patricia Ainsley
Vice President
Vice President
Phone: 904-791-8358
PHONE: 904-791-8136
Dr. Neil Sandler
Mike Davis
Medicare Director
CFO
PHONE: 203-634-5410
PHONE: 904-791-8795
GEORGIA
PART A PROVIDER SERVICE AREA: State of Georgia
PART B JURISDICTION - See Blue Cross and Blue Shield of Alabama
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.
3350 Peachtree Road, N.E.
Atlanta, Georgia 30326
Part A Mailing Address (Claims and Correspondence)
PO Box 9048
Columbus, GA 31908-9048
MEDICARE A BENEFICIARY TOLL-FREE: 1-800-322-3380
MEDICARE A PROVIDER TOLL FREE LINE: 1-877-567-3095
MEDICARE A PROVIDER ENROLLMENT: 1-866-305-0028
PHONE: 706-571-5371(Columbus)
PHONE: 404-842-8000(Atlanta)
PART A - AGREEMENT NO. HCFA 87-001-1.11
FAX: 706-571-5431
INTERNET: www.georgiamedicare.com
Mrs. Monye Connolly
Pamela
Bell
Vacant
Jim
Dresslar
President and Chief
Vice President
Director
Director
Executive Officer
Government Services
Medicare Claims Operations
Provider Audit &
PHONE: 404-842-8509
3350 Peachtree Road, NE
2357 Warm Springs Rd.
Reimbursement
P.O. Box 4445
Suite 200
2357 Warm Springs Rd.
Atlanta , GA 30326
Columbus, GA 31904
Columbus, GA 31904
PHONE: 404-842-8643
P.O. Box 9048
P.O. Box 948
FAX: 404-842-8451
Columbus, GA 31908-9048
Columbus, GA 31908-9048
PHONE: 706-571-5324
PHONE: 706-257-1080
21
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
HAWAII
PART A PROVIDER SERVICE AREA - See United Government Services, LLC
PART B JURISDICTION - See (North Dakota) Noridian Mutual Insurance Company
IDAHO
Part A PROVIDER SERVICE AREA - See North Dakota, Noridian Mutual Insurance Company
Part B JURISDICTION - See Connecticut General Life Insurance Company
ILLINOIS
PART A PROVIDER SERVICE AREA: See Anthem Insurance Companies, Inc.
PART B JURISDICTION: See National Heritage Insurance Company and Wisconsin Physicians Services
INDIANA
PART A PROVIDER SERVICE AREA: States of Indiana, Kentucky, Ohio, Illinois
ANTHEM INSURANCE COMPANIES, INC.
120 Monument Circle, Suite 200
Indianapolis, Indiana 46204
Medicare Operations
AdminaStar Federal , Inc.
8115 Knue Road
Indianapolis, IN 46250
PHONE: 317-841-4400 (Operations Office-AdminaStar, Inc.)
PART A -AGREEMENT NO. HCFA 88-001-1.16
FAX: 317-841-4691
INTERNET:www.adminastar.com
Michael McCarron
Sharon Weddel
President
Regional Vice President
AdminaStar Federal Inc.
Intermediary Operations
8115 Knue Road
Indianapolis, Indiana 46250
22
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
INDIANA
PART B JURISDICTION: States of Indiana, Kentucky
DME Medicare Administrative Contractor for the following States:
Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin (PE)
ADMINASTAR FEDERAL, INC.
8115 Knue Road
Indianapolis, Indiana 46250
PHONE: 317-841-4400 (Operations Office)
FAX: 317-841-4691
PART B - HCFA CONTRACT NO. 88-011-2
INTERNET:www.adminastar.com
DME MAC: HHSM-500-2006-M0002Z
Effective 7/1/06
Michael McCarron
Christine Beard
President
Regional Vice President
AdminaStar Federal Inc.
Carrier & DMERC
8115 Knue Road
Operations
Indianapolis, IN 46250
IOWA
PART A PROVIDER SERVICE AREA: See Blue Cross and Blue Shield of Alabama
PART B JURISDICTION: See (North Dakota) Noridian Mutual Insurance Company
KANSAS
PART A PROVIDER SERVICE AREA: State of Kansas
PART B JURISDICTION: States of Kansas, Western Missouri and Nebraska
BLUE CROSS AND BLUE SHIELD OF KANSAS, INC.
(d.b.a. Wheatlands Administrative Services (WAS))
Street Address:
1133 SW Topeka Blvd.
Topeka, Kansas 66629
Post Office Box 239
Topeka, Kansas 66601-3543
PHONE: 785-291-7000
PART A - AGREEMENT NO. HCFA 87-001-1.19
FAX: 785-291-7098
PART B - CONTRACT NO. HCFA-87-013-2
E-MAIL:bc.medicare@bcbsks.com
Mike Mattox
William H. Pitsenberger
Doug
Scott
President and Chief Executive
Senior Vice President
Chief Operating Officer
Officer
Phone:785-291-8704
P.O.Box 3543
Topeka, Kansas 66601-3543
Phone: 785-291-7371
23
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
KENTUCKY
PART A PROVIDER SERVICE AREA: See State of Indiana, Anthem Insurance Companies, Inc.
PART B JURISDICTION: See State of Indiana, AdminaStar Federal, Inc.
LOUISIANA
PART A PROVIDER SERVICE AREA - See Blue Cross and Blue Shield of Mississippi
PART B JURISDICTION - See Arkansas Blue Cross and Blue Shield
MAINE
PART A PROVIDER SERVICE AREA: State of Maine, State of Massachusetts
(SPECIAL CLAIMS: HHA, Provider-Based HHA/Hospice, RHC)
PART B JURISDICTION - See National Heritage Insurance Company
ANTHEM HEALTH PLANS OF MAINE INC.
(d.b.a. Associated Hospital Service)
110 Free Street
South Portland, Maine 04101-3908
PHONE: 207-253-3348 or 207-253-3645
PART A - AGREEMENT NO. HCFA 87-001-1.22
FAX: 207-253-3645
INTERNET:Medicare@bcbsme.com
David Crowley
Field Office Part A
Field Office Part A
Executive Director
Gene Nickerson, Director
Vincent Guarino, Director
Medicare Operations
Maine Medicare
Massachusetts Medicare
PHONE:207-253-3348
Audit Reimbursement
Audit & Reimbursement
FAX: 207-253-3645
Department
Department
110 Free Street
50 Salem Street, Building A,
Mike McCarron
Portland, Maine 04101-3908
2nd Flood
Medicare Operations Officer
Lynfield, Massachusetts
01940-2694
PHONE: 781-224-0460
MARYLAND
PART A PROVIDER SERVICE AREA: See Pennsylvania – Highmark Inc.
PART B JURISDICTION - See Texas, TrailBlazer Health Enterprises, LLC
MASSACHUSETTS
PART A PROVIDER SERVICE AREA: SeeAnthem HealthPlans of Maine Inc.
PART B JURISDICTION: See National Heritage Insurance Company
MICHIGAN
PART A PROVIDER SERVICE AREA - See United Government Services, LLC
PART B JURISDICTION - See Wisconsin Physicians Service
MINNESOTA
PART A PROVIDER SERVICE AREA: See Noridian Mutual Insurance Company
PART B JURISDICTION: See Wisconsin Physicians Service
MISSISSIPPI
PART A PROVIDER SERVICE AREA: States of Mississippi, Louisiana, and Missouri
24
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
PART B JURISDICTION - See Blue Cross and Blue Shield of Alabama
BLUE CROSS AND BLUE SHIELD OF MISSISSIPPI
(d.b.a. Trispan Health Services)
Medicare Part A Intermediary
(Street Address)
P.O. Box 23046
1064 Flynt Drive
Jackson, Mississippi 39225-3046
Flowood, Mississippi 39232
PHONE: 601-936-0105
PART A - AGREEMENT NO. HCFA 87-001-1.27
FAX: 601-644-4214
INTERNET: www.bcbsms.com
Richard J. Hale
Mr. Jeff Leber
William V. Morris III
President and Chief
Chief Financial Officer
Vice President
Executive Officer
Government Programs and
Government Programs
Benefits Administration
Phone:601-664-4570
FAX:601-664-4214
MISSOURI
PART A PROVIDER SERVICE AREA - See Blue Cross and Blue Shield of Mississippi and Mutual of Omaha Ins.
Co.
PART B JURISDICTION - See Blue Cross and Blue Shield of Kansas, Inc. for Western Missouri and
Arkansas Blue Cross and Blue Shield of Eastern Missouri
MONTANA PART A PROVIDER SERVICE AREA: See (North Dakota) Part A/B MAC Noridian Administrative Services
PART B JURISDICTION: See (North Dakota) Part A/B MAC Noridian Administrative Services
25
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
NEBRASKA
PART A PROVIDER SERVICE AREA: State of Nebraska
PART B JURISDICTION - See Blue Cross and Blue Shield of Kansas, Inc.
BLUE CROSS AND BLUE SHIELD OF NEBRASKA
P.O. Box 24563
Omaha, Nebraska 68124-0563
STREET ADDRESS:
7261 Mercy Road
Omaha, Nebraska 68124
PHONE: 402-390-1800 (Switch Board)
PART A - AGREEMENT NO. HCFA 87-001-1.31
FAX: 402-398-3640 (Corporate office)
Steve Martin
Duane Wilson
Barbra Buls
President & CEO
Treasurer and Chief Financial
Vice President
Officer
Government Programs
PHONE: 402-343-3366
FAX: 402-398-3640
NEVADA
PART A PROVIDER SERVICE AREA - See United Government Services, LLC
PART B JURISDICTION - See Noridian Mutual Insurance Company (North Dakota)
NEW HAMPSHIRE PART A PROVIDER SERVICE AREA: States of New Hampshire and Vermont
(SPECIAL CLAIMS: RHC )
PART B JURISDICTION - See National Heritage Insurance Company
ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.
(d.b.a. Anthem Blue Cross and Blue Shield of New Hampshire)
43 Constitution Drive
Suite 202
Bedford, New Hampshire 03111
PHONE: 603-695-7000
PART A - AGREEMENT NO. HCFA 87-001-1.32
FAX: 603-695-7524 (notify recipient of fax)
David Crowley
Michael McCarron
Field Office Part A
Executive Director of Medicare Operations
Medicare Operations Officer
Mrs. Jerri Probost, Director
PHONE: 207-253-3348
New Hampshire Medicare Audit
FAX: 207-253-3645
Reimbursement Drive, Suite 202
Bedford, New Hampshire 03111
PHONE: 603-472-7551
NEW JERSEY
PART A PROVIDER SERVICE AREA: See Blue Cross Blue Shield of Tennessee (d.b.a.
Riverbend Government Benefits Administrators)
PART B JURISDICTION - See Empire HealthChoice, Inc.(New York)
NEW MEXICO
PART A PROVIDER SERVICE AREA: See Texas- TrailBlazer Health Enterprises, LLC and Palmetto
GBA, LLC (South Carolina) (HHA claims only)
PART B JURISDICTION -See Arkansas Blue Cross and Blue Shield A Mutual Insurance Company
26
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
NEW YORK
PART A PROVIDER SERVICE AREA: States of New York, Delaware, and Connecticut
PART B JURISDICTION: Counties of Bronx, Columbia, Delaware, Duchess, Greene, Kings, Nassau, New
York, Orange, Putnam, Richmond, Rockland, Suffolk, Sullivan, Ulster, Westchester and State of New Jersey.
(Also - See HealthNow New York Inc. and Group Health Incorporated)
EMPIRE HEALTHCHOICE ASSURANCE, INC.
(d.b.a. Empire Medicare Services)
PART A - AGREEMENT NO. HCFA 87-001-1.38
FAX: 914-248-2948
PART B - CONTRACT NO. HCFA 87-021-2
INTERNET: lloyd.kasow@empireblue.com
Michael A. Stocker, M.D.
Gloria McCarthy
Michael
McCarron
Christine Thomas
President & CEO
Executive Vice President &
Medicare Operations Officer
Assistant Vice President
11 West 42 Street
Chief Operating Officer
Public Relations & Medicare
New York, NY 10036
11 West 42 Street
Part A Operations
New York, NY 10036
400 South Salina Street
Syracuse, NY 13202
PHONE: 315-442-4530
Karen Turner
Steven C. Cline
Director
Director
Medicare Part B NY
Medicare Part B New Jersey
Operations
Operations
2651 Strang Blvd.
300 East Park Drive
Yorktown Heights, NY
Harrisburg, PA 17111
10598
PHONE: 717-565-3494
PHONE: 914-248-3218
27
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
NEW YORK
PART B JURISDICTION: The State of New York-Counties-Albany, Allegany, Broome, Cattaraugus, Cayuga,
Chautauqua, Chenango, Chemung, Clinton, Cortland, Erie, Essex, Franklin, Fulton, Genesee, Hamilton, Herkimer,
Jefferson, Lewis, Livingston, Madison, Monroe, Montgomery, Niagara, Oneida, Ontario, Onondaga, Orleans, Oswego,
Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Schuyler, Seneca, Steuben, St. Lawrence, Tioga, Tompkins,
Warren, Washington, Wayne, Wyoming, and Yates (except for the Counties served by Empire Health Choice, Inc. and
Group Health, Inc.)
HEALTHNOW NEW YORK, INC.
1901 Main Street,
Buffalo, New York 14208
P.O. Box 80, Buffalo, New York 14240-0080
UPSTATE MEDICARE DIVISION
HealthNow New York Inc.
33 Lewis Road
Binghamton, New York 13905
P.O. Box 5236
Binghamton, NY 13902-5236
PHONE: 716-887-6900 (Buffalo)
PART B - CONTRACT NO. HCFA 87-022-2
FAX: 716-887-8548 (Buffalo)
www.umd.nycpic.com
James Dickerson
Mr. Dennis Gorski
Alphonso
O’Neil-White
Ex. Vice President
Sr. Vice President
President & Chief Executive
Chief Financial
Government Programs
Officer
Officer and Treasurer
PHONE: 716-887-6027
PHONE: 716-887-8508
PHONE: 716-887-2025
E-mail:
E-mail:
E-mail:
Gorski.dennis
O’Neil-White.Alphonso
Dickerson. James
@Healthnow.org
@Healthnow.org
@Healthnow.org
Upstate Medicare Division
Upstate Medicare Division
DMERC
HealthNow New York Inc.
Joli Juodaitis
(See Upstate Medicare
33 Lewis Rd.
Managing Director
Division)
Binghamton, NY 13905
Upstate Medicare Division
Joli Juodaitis
Phone: 607-766-6000 (UMD)
PHONE: 607-766-6270
Managing Director
Fax: 607-766-6395 (UMD)
E-mail:
PHONE: 607-766-6325
Juodaitis.joli@healthnow.org
FAX: 607-766-6395
P.O. Box 5236
Juodaitis.joli@healthnow.org
Binghamton, NY 13902-
5236
NORTH CAROLINA
PART A PROVIDER SERVICE AREA: See Palmetto GBA, LLC (South Carolina)
PART B JURISDICTION - See Connecticut General Life Insurance Company
28
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
NORTH DAKOTA
PART A PROVIDER SERVICE AREA: State of Minnesota, Washington, Alaska, Oregon, and Clark
County in State of Washington
PART B JURISDICATION: States of Colorado, Northern Marianna Islands, American Samoa, Guam,
Washington, Hawaii, Oregon, Alaska, Arizona, Nevada, and Iowa
Noridian Administrative Services: DME Medicare Administrative Contractor for the following states:
Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana,
Nebraska, Nevada, North Dakota, Northern Mariana Islands Oregon, South Dakota, Utah, Washington, and
Wyoming.
NORIDIAN MUTUAL INSURANCE COMPANY
(d.b.a. Noridian Administrative Services, LLC)
901 40th St. S
Suite 1
Fargo, ND 58103
PHONE: 701-277-6500
PART A - AGREEMENT NO. HCFA 87-001-1.44
FAX: 701-277-5150
PART B - CONTRACT NO. HCFA 87-023-2
www.noridianmedicare.com
DME MAC HHSM-500-2006-M00042
effective 7/01/06
Part A/BMAC – HHSM-500-2006-M0005Z
Michael Hamerlik
Jay Martinson
President and Chief
Executive Vice President & COO
Executive Officer
PHONE: 701-282-1439
PHONE: 701-282-1868
Provider Call Center - Part A
ND/MN - 1-866-380-4741
WA/AK - 1-877-908-8437
Beneficiary Call Center - Part A
1-800-633-4227
Provider Call Center - Part B
Automated Response Unit (ARU) (877) 908-8431
Provider Call Center (800) 933-0614
Provider Call Center (Iowa Only) (866) 502-9057
Phone Appeals (800) 279-5331
Provider Enrollment (888) 608-8816
HIPPA & EDI Support Services (800) 967-7902
TTY (888) 261-4163
TTY (Iowa Only) (888) 819-9945
Beneficiary Call Center - Part B
1-800-633-4227
Beneficiary TDD (888) 552-9336
PART A/B MAC - Noridian Administrative Services, LLC
Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming
29
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
OHIO
PART A PROVIDER SERVICE AREA: See State of Indiana, Anthem Insurance Companies Inc.
PART B JURISDICTION - See Palmetto GBA, LLC (South Carolina)
OKLAHOMA
PART A PROVIDER SERVICE AREA: State of Oklahoma
PART B JURISDICTION - See Arkansas Blue Cross and Blue Shield a Mutual Insurance Company
HEALTH CARE SERVICE CORPORATION
(d.b.a. BLUE CROSS AND BLUE SHIELD OF OKLAHOMA)
(Division of Health Care Service Corporation)
1215 South Boulder Avenue
Tulsa, Oklahoma 74119
PHONE: 918-560-3500
PART A - AGREEMENT NO. HCFA 87-001-1.52
FAX: 918-560-3506
INTERNET:medicare@bcbsok.com
Mr. Wyndham Kidd
Ms. Garoldine Webb
President
Senior Director
PHONE: 918-551-2088
Government Programs
A Division of HCSC
PHONE: 918-551-2090
FAX: 918-560-3506
OREGON
PART A PROVIDER SERVICE AREA: States of Oregon , Idaho- See North Dakota, Noridian Mutual Insurance
Company and Utah and also Clark County in the State of Washington –See North Dakota, Noridan Mutual Insurance
Company
PART B JURISDICTION - See (North Dakota) Noridian Mutual Insurance Company
30
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
PENNSYLVANIA
PART A PROVIDER SERVICE AREA: Pennsylvania, Maryland and District of Columbia (SPECIAL
CLAIMS: RHC)
HIGHMARK INC.
(d.b.a. Highmark Medicare Services)
120 Fifth Avenue, Suite P5101
Pittsburgh, Pennsylvania 15222-3099
PHONE: 412-544-7000
PART A -AGREEMENT NO. HCFA 87-001-1.56
FAX: 412-544-8054
BENEFICIARY CALLS ONLY:1-800-853-1419
INTERNET:veritusmedicare@highmark.com
WWW.veritusmedicare.com
Kenneth Melani, M.D.
Robert C. Gray
Dave O’Brien
Address all technical and
President and Chief
Executive Vice President
Executive Vice President
procedural correspondence
Executive Officer
Finance & Subsidiary
Government Services
to:
Highmark Inc.
Services
1800 Center Street, Room
Patrick M. Kiley
120 Fifth Avenue, FAP3111
Highmark Inc.
400
Senior Vice President
Pitsburgh, Pennsylvnia
120 Fifth Ave., FAP 3116
Camp Hill, PA 17089-0065
Highmark Inc.
15222-3099
Pittsubrg, PA 15222
PHONE:412-544-8870-
P.O. Box 890089
PHONE: 412-544-8202
PHONE: 717-763-6274
Pittsburgh
Camp Hill, PA 17089-0089
Camphill Office
PHONE:717-763-6568-
PHONE: 717-302-3707
HGSAdministrators
Camphill
patrick.kiley@hgsa.com
P.O. Box 890089
Campbhll, PA 17089-0089
Phone: 717-302-4387
PENNSYLVANIA PART B JURISDICTION: State of Pennsylvania
HIGHMARK INC.
(d.b.a. Highmark Medicare Services)
P.O. Box 890089
Camp Hill, Pennsylvania 17089-0089
FOR EXPRESS MAIL:
1800 Center Street
Camp Hill, Pennsylvania 17089
PHONE: 1-800-662-0849 (Center Street)
PART B - CONTRACT NO. HCFA 87-025-2
FAX: 717-302-3710 (Center Street)
INTERNET:www.hgsa@hgsa.com
Kenneth Melani, M.D.
Robert C. Gray
David M. O’Brien
Address All Technical and
President & CEO
Executive Vice President
Executive Vice President
Procedural Correspondence
Highmark, Inc.
Finance & Subsidiary
Government Services
to:
120 Fifth Avenue, Suite 3111
Services
Pittsburg Office
Patrick M. Kiley
Pittsburgh, PA 15222
Pittsburgh Office
Highmark Inc.
Senior Vice President
PHONE: 717-302-3712
Highmark Inc.
120 Fifth Avenue
Highmark Inc.
120 Fifth Avenue, FAP3116
Pittsburg, PA 15222
P.O. Box 890089
Andrew Bloschichak, M.D.
Pittsburgh, PA 15222
PHONE:412-544-5250
Camp Hill, PA 17089-0089
MBA,VP & Carrier Med.Dir.
PHONE:412-544-7526
Camp Hill Office
PHONE: 717-302-3707
HGSAdministrators Program
Camp Hill Office
HGSAdministrators
patrick.kiley@hgsa.com
Safeguards
HGSAdministrators
P.O. Box 890089
1800 Center Street, 1A-L3
P.O. Box 890089
Camp Hill, PA 17089-0089
P.O. Box 890089
Camp Hill, PA 17089-0089
PHONE:717-302-3865
Camp Hill, PA 17089-0089
PHONE:717-302-4387
Phone: 717-302-4198
31
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
PUERTO RICO
PART A PROVIDER SERVICE: See Cooperativa de Seguros de Puerto Rico
PART B JURISDICTION: Puerto Rico and U.S. Virgin Islands
TRIPLE-S, INC.
Box 71391
San Juan, Puerto Rico 00936-1391
STREET ADDRESS:
1441 F.D. Roosevelt Avenue
Caparra, Puerto Rico 00920
PHONE: 787-749-4949 (Switch Board)
PART B- CONTRACT NO. HCFA 87-033-2
Community Relations (Medicare)
Provider:787-749-4232
Provider Toll Free Line: 1-877-715-1921
Beneficiaires:787-749-4900
Beneficiary Toll Free Line:787-981-7015
Fax:787-749-4900
Internet:mortiz@triples-med.org
Website:www.triples-med.org
Mr. Ramon Ruiz Mortiz
Mrs. Socorro Rivas
Mrs. Gloria Lebrón, Esq.
Mr. Carlos Gonzales, Esq.
President and CEO
President & CEO
Vice President
Assistant Vice President
Triple-S Management Corp.
Triple S, Inc.
Medicare
Medicare
PHONE: 787-749-4113
PHONE: 787-749-4118
PHONE: 787-749-4083
PHONE: 787-277-6691
FAX: 787-749-4091
FAX: 787-749-4001
FAX: 787-749-4092
FAX: 787-749-4092
RHODE ISLAND
PART A PROVIDER SERVICE AREA: See Arkansas Blue Cross and Blue Shield
PART B JURISDICTION: See Arkansas Blue Cross and Blue Shield
32
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
SOUTH CAROLINA
PART A PROVIDER SERVICE AREA: State of South Carolina and North Carolina (SPECIAL
CLAIMS: HHA, Hospices)
PART B JURISDICTION: State of South Carolina , Ohio & West Virginia
DME REGIONAL MEDICARE ADMINISTRATIVE CONTRACTOR for the following States:
Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi,
New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas,
Virgin Islands, Virginia, and West Virginia (PE)
Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC)
National Supplier Clearinghouse (NSC)
Special Claims - RRB
RHHI: Kentucky, North Carolina, South Carolina, Tennessee, Alabama, Florida, Georgia,
Mississippi, Arkansas, Louisiana, New Mexico, Oklahoma, Texas, Illinois, Indiana, and Ohio
Palmetto GBA, LLC
17 Technology Circle
Columbia, South Carolina 29203-9511
PHONE: 803-735-1034
PART A - AGREEMENT NO. HCFA 87-001-1.59
FAX: 803-945-0081
INTERNET: rose.voyles@palmettogba.com
Bruce W. Hughes
Neal Burkhead
Ann Archibald
Joe Wright
President
Vice President
Vice President
Vice President, CFO
& Chief Operating Officer
Medicare Integrity Programs
Compliance Officer
17 Technology Circle
17 Technology Circle
& Part A Operations
17 Technology Circle
Mail Code: AG-A15
Mail Code: AG-A03
17 Technology Circle
Mail Code: AG-A02
Columbia, SC 29203-9511
Columbia, SC 29203-9511
Mail Coe: AG-A11
Columbia, SC 29202-9511
Phone: 803-763-5544
PHONE: 803-763-7130
Columbia, SC 29203-9511
PHONE: 803-763-8700
FAX: 803-935-0176
FAX: 803-935-0081
PHONE: 803-763-1535
FAX: 803-763-7115
FAX:803-935-0176
Rex Brown
Dickie
Butler
Elaine
Myers
Sheri Thompson
Assistant VP
Vice President
Vice President
Assistant VP
Customer Service Strategies
Medicare Systems/EDI
Customer Service Stratagies
17 Technicology Circle
17 Technology Circle
17 Technology Circle
17 Technology Circle
Mail Code AG-A04
Mail code AG-A21
Mail Code: AG-A08
Mail Code: AG-13
Columbia, SC 29203-9511
Columbia, SC 29203-9511
Columbia, SC 29203-9511
Columbia, SC 29203-9511
PHONE: 803-763-5545
PHONE: 830-763-4622
PHONE: 803-763-1077
PHONE: 803-763-5505
FAX: 803-935-1411
FAX: 803-935-1411
FAX: 803-935-1411
FAX: 803-935-1411
33
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
PALMETTO GBA, LLC
PART B JURISDICTION: State of South Carolina , Ohio & West Virginia
DME REGIONAL MEDICARE ADMINISTRATIVE CONTRACTOR for the following States:
DME REGIONAL MEDICARE ADMINISTRATIVE CONTRACTOR for the following States:
Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South
Carolina, Tennessee, Texas,Virgin Islands, Virginia, and West Virginia (PE)
Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC)
National Supplier Clearinghouse (NSC)
Special Claims - RRB
EXECUTIVE OFFICES
OPERATIONS OFFICES:
17 Technology Circle
P.O. Box 100190
Columbia, South Carolina 29203-9511
Columbia, South Carolina 29202-3190
PHONE: 803-735-1034
PART B - CONTRACT NO. HCFA 87-027-2
Part B – OORRB005
FAX: 803-945-0081
DMERC Contract No. HCFA 500-93-BPO-3
INTERNET:rose.voyles@palmettogba.com
INTERNET-DMERC: rose.voyles@palmettogba.com
Bruce W. Hughes
Ann
Archibald
Neal
Burkhead
Dickie
Butler
President
Vice President
Vice President
Vice President
& Chief Operating Officer
Compliance Officer
Medicare Integrity Program
Medicare Systems/EDI
17 Technology Circle
17 Technology Circle
17 Technology Circle
17 Technology Circle
Mail Code: AG-A03
Mail Code: AG-A02
Mail Code: AG-A11
Mail Code: AG-A08
Columbia, SC 29203-9511
Columbia, SC 29202-9511
Columbia, SC 29203-9511
Columbia, SC 29203-9511
PHONE: 803-763-7130
PHONE: 803-763-8700
PHONE: 803-763-1535
PHONE: 803-763-1077
FAX: 803-935-0081
FAX: 803-763-7115
FAX: 803-935-0176
FAX: 803-935-1411
DURABLE MEDICAL
EQUIPMENT
Rex Brown
Mike Barlow
Joe Wright
Robin Spires
Assistant VP
Vice President
Vice President
Vice President
Customer Service Strategies
Ohio/West Virginia
Chief Financial Operations
DMERC Operations
17 Technology Circle
Operations
17 Technology Circle
17 Technology Circle
Mail code AG-A21
4249 Easton Way
Mail Code: AG-A15
Mail Code: AG-A13
Columbia, SC 29203-9511
Columbus, Ohio 43219
Coolumbia, SC 29203-9511
Columbia, SC 29203-9511
PHONE: 830-763-4622
PHONE: 614-473-6400
PHONE: 803-763-5544
PHONE:803-763-5704
FAX: 803-935-1411
FAX: 614-473-6803
FAX: 803-935-0176
FAX:803-935-1411
Jean Catalano
Elaine
Meyers
Sharon
Cook-McEwen
Assistant Vice President
Vice President
Assist VP
Railroad Medicare
Customer Service Strategies
South Carolina Part B
Operations
17 Technology Circle
Opeations
2743 Perimeter Parkway
Mail Code: AG-13
17 Technology Circle
Building 200, Suite 400
Columbia, SC 29203-9511
MC AG-A09
Augusta, GA 30909
PHONE: 803-763-5505
Columbia, SC 29203-9511
PHONE: 706-855-3130
FAX: 803-935-1411
PHONE: 803-763-1250
FAX: 706-855-3132
FAX: 803-935-1411
34
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
SOUTH DAKOTA PART A PROVIDER SERVICE AREA - See Blue Cross and Blue Shield of Alabama
PART B JURISDICTION- See North Dakota-Noridian Mutual Insurance Company
TENNESSEE
PART A PROVIDER SERVICE AREA: State of Tennessee and New Jersey (SPECIAL CLAIMS: RHC,
CSC, OPO, HL, LPIC)
PART B JURISDICTION - See Connecticut General Life Insurance Company
BLUE CROSS AND BLUE SHIELD OF TENNESSEE
(d.b.a. Riverbend Government Benefits Administrator)
801 Pine Street
Chattanooga, Tennessee 37402
Medicare Address: 730 Chestnut Street Chattanooga, TN 37402
PHONE:1-866-641-2007 (Medicare Beneficiary)(Toll Free)
PART A - AGREEMENT NO. HCFA 87-001-1.60
Provider Line: 877-296-6189 (toll free)
FAX: 423-752-6518
INTERNET:RGBA_CRS@bcbst.com
Vicky Gregg
Rodney Woods
David
Jackson
President & CEO
Vice President
Director
Medicare Operations
Medicare Integrity Program
PHONE: 423-752-7927
and Reimbursement
FAX:423-763-3537
PHONE:423-755-5806
TEXAS
PART A PROVIDER SERVICE AREA: State of Texas, New Mexico and Colorado
PART B JURISDICTION: States of Texas, Maryland, Delaware, District of Columbia, City of Alexandria, Arlington
and Fairfax Counties in Virginia and Virginia (Special Claims: RHC)
TRAILBLAZER HEALTH ENTERPRISES, LLC
P.O. Box 660156
Dallas, Texas 75266-0156
STREET ADDRESS:
8330 LBJ Freeway, Executive Center 3
Dallas, Texas 75243
PHONE: 469-372-1816
PART A - AGREEMENT NO. HCFA 87-001-1.62
FAX: 469-372-1765
PART B - CONTRACT NO. HCFA 87-029-2
EMAIL: tb.mail@trailblazerhealth.com
Ms. Marti Mahaffey
President & Chief Operating
Officer
PHONE:469-372-1701
35
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
UTAH PART A PROVIDER SERVICE AREA: See North Dakota – Noridian Mutual Insurance Company
PART B JURISDICTION: See North Dakota – Noridian Mutual Insurance Company
VERMONT PART A PROVIDER SERVICE AREA - See Anthem HealthPlans of New Hampshire, Inc.
PART B JURISDICTION - See National Heritage Insurance Company
VIRGINIA - PART A PROVIDER SERVICE AREA: See United Government Services, LLC
PART B JURISDICTION - See TrailBlazer Health Enterprises, LLC
WASHINGTON
PART A PROVIDER SERVICE AREA: See Noridian Mutual Ins. Co. (North Dakota)
PART B JURISDICTION - See Noridian Mutual Ins. Co.(North Dakota)
WEST VIRGINIA
PART A PROVIDER SERVICE AREA- See United Government Services, LLC
PART B JURISDICTION - See Palmetto GBA, LLC ( South Carolina)
36
SECTION II - PART A INTERMEDIARIES AND PART B CARRIERS
WISCONSIN
PART A PROVIDER SERVICE AREA: States of Wisconsin, Michigan, Virginia, West Virginia, California,
Nevada, Hawaii, Guam, Northern Marian Islands, American Samoa (SPECIAL CLAIMS: HHA, Hospice and
FQHC, Independent Hospice West)
PART B JURISDICTION - See Wisconsin Physicians Service Insurance Corporation
UNITED GOVERNMENT SERVICES, LLC
6775 W. Washington Street
Milwaukee, Wisconsin 53214-5644
PHONE: 414-459-6203
INTERNET:www.ugsmedicare.com
PART A - AGREEMENT NO. HCFA 87-001-1.70
FAX: 414-459-5226
EMAIL: UGSadmin@ugswlp.com
Provider Inquiries
Milwaukee Office: 1-877-309-4290
1-866-419-9462 (Michigan)
Roanoke Office: 1-877-908-8474
Timothy F. Cullen
Janine Harris
Michael McCarron
Senior Vice President
Vice President-Human
President
Wellpoint Inc.
Resources &
PHONE: 414-459-6004
Administration, United
Government Services, LLC
PHONE: 414-459-5160
Steve Holubowicz
Liz Bartlett
Shig Kimoto
Vice President of Program
Vice President & General
Vice President, Information
Safeguards, United
Counsel
Technology
Government
United Government
United Government
Services, LLC
Services, LLC
Services, LLC.
PHONE: 414-459-6991
PHONE: 414-459-6777
PHONE: 805-367-1010
Todd Reiger
Director of Finance
United Government
Services, LLC
PHONE:414-459-5606
WYOMING PART A/B MAC– See (North Dakota) Noridian Administrative Services
37
SECTION II – PART A INTERMEDIARIES AND PART B CARRIERS
SECTION III - COMMERCIAL AND INDEPENDENTS - PART A & B
COOPERATIVA DE SEGUROS DE VIDA DE PUERTO RICO
GPO Box 363428
San Juan, Puerto Rico 00936-3428
STREET ADDRESS:
400 Americo Miranda Avenue
San Juan, Puerto Rico 00927
PART A PROVIDER SERVICE AREA: Puerto Rico and U.S. Virgin Islands
PHONE: 787-758-9733(switchboard)
PART A - AGREEMENT NO. HCFA 87-326-1
FAX: 787-756-8199
Alba Cosme
Sandra
Pena
Mr. William Zayas
Carlos Fernandez
Vice President
Assistant Vice President
Assistant Vice President
President
Medicare
Medicare Operations
Audit & Reimbursement
PHONE: 787-764-8469
PHONE: 787-763-2053
PHONE: 787-758-8615
PHONE: 787-765-2570
Ada Velez
Carlos Gonzalez
Medical Review & Analysis
CFO
PHONE: 787-758-2205
PHONE: 787-772-4185
38
SECTION III - COMMERICAL AND INDEPENDENTS - PART A & B
CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC), a CIGNA Company
(d.b.a. CIGNA Government Services (CGS)
Hartford, Connecticut 06152
PART B JURISDICTION: States of Idaho, North Carolina, Tennessee
CIGNA Government Services: DME Medicare Administrative Contractor for the following States: Alaska, Arizona, California,
Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington,
Wyoming, (PE)
PHONE: 615-244-5600
PART B - CONTRACT NO. HCFA 91-330-2
FAX: 615-782-4445
DME MAC HHSM-500-2006-M0006Z
www.cignagovernmentservices.com
Email: CIGNAPARTB@cigna.com
Email: CIGNADMERC@cigna.com
Brian Setzer
Vice President
Karen Schneider
Jeff Chambers
CIGNA Government Services
Vice President, New Business
Assistant Vice President, Finance
Two Vantage Way
Development
CIGNA Government Services
Nashville, TN 37228
CIGNA Government Services
Two Vantage Way
PHONE: 615-782-4618
Two Vantage Way
Nashville, TN 37228
FAX: 615-782-4695
Nashville, TN 37228
PHONE: 615-782-4676
Brian.setzer@cigna.com
PHONE: 615-782-4547
FAX: 615-782-4622
FAX: 615-782-4695
jeff.chambers@cigna.com
karen.schneider@cigna.com
Jean Rush
Michael Logan
Kay Kretsch
President
Chief Compliance Officer
Assistant Vice President
CIGNA Government Services
CIGNA Government Services
Part B Operations
900 Cottage Grove Road, S353
Two Vantage Way
CIGNA Government Services
Hartford, CT 06152
Nashville, TN 37228
Two Vantage Way
PHONE:860-226-4690
PHONE: 615-782-4595
Nashville, TN 37228
FAX: 860-226-5060
FAX: 615-782-0182
PHONE: 615-782-4525
jean.rush@cigna.com
michael.logan@cigna.com
FAX:615-782-4627
kay.kretsch@cigna.com
CLAIMS SYSTEMS
DURABLE MEDICAL
EQUIPMENT
John Kimball
Chief Information Officer
Melissa Kirchenbauer
CIGNA Government Services
Assistant Vice President
Two Vantage Way
DMERC Operations
Nashville, TN 37228
CIGNA Government Services
PHONE: 615-782-4678
Two Vantage Way
FAX: 615-782-0187
Nashville, TN 37228
John. Kimball@cigna.com
PHONE: 615-782-4692
FAX: 615-782-4626
Melissa.kirchenbauer @cigna.com
39
SECTION III - COMMERICAL AND INDEPENDENTS - PART A & B
GROUP HEALTH INCORPORATED
25 Broadway
New York, New York 10004
PART B JURISDICTION: Queens County, New York
PHONE: 646-458-6600
PART B - CONTRACT NO. HCFA 87-320-2
FAX: 646-458-6761
Peter S. Moore
Jim
Brady
Vice President
Director of Medicare
PHONE: 646-458-6601
Operations
Program Evaluation and
Integrity
PHONE: 646-458-6682
FAX: 646-458-6761
HAWAII
PART A PROVIDER SERVICE AREA: See United Government Services, LLC
PART B JURSDICTION: See Noridian Mutual Insurance Company (North Dakota)
UNITED HEALTH CARE INSURANCE COMPANY
PART A PROVIDER SERVICE AREA: See Empire HealthChoice, Inc (New York) and United Government Services (Wisconsin)
PART B JURISDICTION: First Coast Service Options, Inc.(CT), Wisconsin Physician Services(MN), BCBSAL (MS), TrailBlazer
Health Enterprises (VA), DME Reg. Carrier- HealthNow
40
SECTION III - COMMERICAL AND INDEPENDENTS - PART A & B
MUTUAL OF OMAHA INSURANCE COMPANY
PART A PROVIDER SERVICE AREA: Available in most states (except New York and Puerto Rico)
Mutual of Omaha
P.O. Box 1602
Omaha, Nebraska 68101
Street Address:
Mutual of Omaha Plaza
Omaha, Nebraska 68175
PHONE: 402-342-7600
PART A - AGREEMENT NO. HCFA 87-319-1
FAX: 402-351-8047
INTERNET: WWW.mutualmedicare.com
Ms. Janet Kyle
Elizabeth Powers
Shelly Foxworthy
Patrica Allmon
First Vice President
First Vice President
First Vice President Audit &
First Vice President
Mutual of Omaha
Medicare Admin. Systems
Reimbursement
Medicare Claims Program
P.O. Box 1602
Mutual of Omaha
Mutual of Omaha
Mutual of Omaha Insurance
Omaha, NE 68101
P.O. Box 1602
P.O. Box 1604
Company
PHONE: 402-351-6940
Omaha, NE 68101
Omaha, NE 68101
P.O Box 1602
FAX:402-351-8047
PHONE: 402-351-2570
PHONE:402-351-5377
Omaha, NE 68101
EMAIL:
FAX:402-351-8047
FAX:402-351-8796
PHONE:402-351-3205
janet.kyle@
EMAIL:
EMAIL:
FAX:402-351-8047
Mutualofomaha.com
liz.powers@
shelly.foxworthy@
EMAIL:trish.allmon@mutualof
Mutualofomaha.com
Mutualofomaha.com
omaha.com
Karen Alexander
First Vice President
Janet Kyle
Charles Hagen
Quality Improvement Programs
First President
First Vice President
Mutual of Omaha Insurance Co.
Finance
Medial Compliance
P.O. Box 1602
Mutual of Omaha Ins. Co.
Mutual of Omaha Ins. Co.
Omaha, NE 68101
P.O. Box 1602
P.O. Box 1602
PHONE:402-351-4237
Omaha, NE 68101
Omaha, NE 68101
FAX:402-351-5931
PHONE: 402-351-6940
PHONE: 402-351-3614
EMAI:Karen.Alexander@
FAX: 401-351-8047
EMAIL: charles.hagen@
mutualofomaha.com
EMAIL: janet.kyle@
Mutualofomaha.com
mutualofomaha.com
41
SECTION III - COMMERICAL AND INDEPENDENTS - PART A & B
MUTUAL OF OMAHA FIELD OFFICES
DENVER, CO
SACRAMENTO, CA
LOS ANGELES, CA
DALLAS, TX
Rick Keegan
Dan Dahl
Richard Eclarin
Geoge Pietri
Field Audit Manager
Field Audit Manager
Field Audit Manager
Field Audit Manager
Panorama Corporate
Capital Professional Center
901 Corporate Center
14200 Midway Road
Center V
2200 B Douglas Blvd.
Drive, Suite 405
Suite 125
9200 E. Panorama Circle
Suite 275
Monterey Park, CA 91754
Dallas, TX 75244
Suite 225
Roseville, CA 95661
Englewood, CO 80112-
PHONE: 323-881-9586
PHONE: 972-386-4061
3481
PHONE: 916-774-9275
FAX: 323-881-9534
FAX: 972-233-9406
FAX: 916-774-1112
EMAIL: rick.eclarin@
EMAIL:
PHONE:303-925-0065
EMAIL:dan.dahl@Mutual
Mutualofomaha.com
neil.milbrandt@mutualofo
FAX:303-925-0969
ofomaha.com
maha.com
EMAIL: rick.keegan@
Mutualofomaha.com
KANSAS CITY, MO
ST. LOUIS, MO
CLEARWATER, FL
Marilyn Huskamp
Mike Connelly
Cynthia MacDonald, CPA
Field Audit Manager
Field Audit Manager
Field Audit Manager
10220 North Executive
11701 Borman Drive
33920 U.S. Highway 19
Hills Blvd., Suite 220
Suite 220
North, Suite 360
Kansas City, MO 64153
St. Louis, MO 63146-4193
Palm Harbor, FL 34684
PHONE: 816-891-6500
PHONE: 314-997-6626
PHONE:727-772-2557
FAX: 816-891-8817
FAX: 314-997-6997
FAX: 727-772-7193
EMAIL:
EMAIL:
EMAIL:
marylin.huskamp@mutualof
mike.connelly@mutualofoma
cynthia.macdonald@mutualo
omaha.com
ha.
fomaha.com
com
ATLANTA, GA
CHICAGO, IL
HARFORD, CT
Linda Smallwood
Art Garvida
James Zanavich
Field Audit Manager
Field Audit Manager
Field Audit Manager
2400 Herodian Way
377 East Butterfield Road
655 Winding Brook Dr.
Suite 300
Suite 260
Glastonbury, CT 06033
Smyrna, GA 30080
Lombard, Il 60148
PHONE: 770-988-9052
PHONE: 630-810-1324
PHONE: 860-659-4300
FAX: 770-988-9065
FAX: 630-810-1368
FAX: 860-659-8065
EMAIL: linda
EMAIL: art.garvida@
EMAIL: jim.zanavich@
smallwood@mutualofoma
Mutualofomaha.com
Mutualofomaha.com
ha.com
42
SECTION III – COMMERCIAL AND INDEPENDENTS – PART A & B
NATIONAL HERITAGE INSURANCE COMPANY
75 Sgt. William Terry Drive
Hingham, MA 02043
PART B JURISDICTION: States of California, Maine, Massachusetts, New Hampshire, Vermont
DME MEDICARE ADMINISTRATIVE CONTRACTOR for the following states: Connecticut, Delaware, District of Columbia,
Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont (PE)
PHONE: 530-634-7400
PART B - CONTRACT NO. HCFA-96-331-2
DME MAC Contract – HHSM-500-2006-M0001Z
Effective 7/1/06
INTERNET:www.medicarenhic.com
CAIFORNIA (Northern)
Beneficiary Services – 1-800-Medicare
Provider Services – 877-591-1587
(All counties except San Luis Obispo, Santa Barbara, Ventura os Angeles, Orange, San Diego and Imperial)
CALIFORNIA (Southern)
Beneficiary Services – 1-800-Medicare
Provider Services – 866-502-9054
(For the counties of San Luis Obispo, Santa Barbara, Ventura, Los Angeles, Orange, San Diego and Imperial)
MAINE
Beneficiary Services – 800-492-0919
Provider Services – 877-567-3129
MASSACHUSETTS
Beneficiary Services – 800-882-1228
Provider Services – 877-567-3130
NEW HAMPSHIRE/VERMONT
Beneficiary Services – 800-447-1142
Provider Services – 866-539-5595
43
SECTION III – COMMERCIAL AND INDEPENDENTS – PART A & B
NATIONAL HERIAGE INSURANCE COMPANY CONTINUED
Donald S. Picard
Anne Bockhoff Dalton
Colleen
Cerullo
Vice President
Vice President
Administrative Assistant
Medicare
NHIC, Corp
NHIC, Corp.
Mail Stop AGN-C54
75 Sgt. William Terry Drive
75 Sgt. William Terry Drive
13600 EDS Drive
Hingham, MA 02043
Hingham, MA 02043
Herndon, VA 20171
PHONE:781-741-3201
PHONE: 781-741-3136
Phone:703-742-2280
FAX:781-741-3582
FAX: 781-741-3211
FAX: 703-742-2886
Paul Ackerman
Andrew Conn
Director of Southern California
Director of Claims Operations &
NHIC, Corp.
Service Operations
Northern California Service Operations
75 Sgt. William Terry Drive
NHIC, Corp
NHIC, Corp.
Hingham, MA 02043
1055 West 7th Street, Suite 500
75 Sgt. Willliam Terry Drive
PHONE: 781-741-3255
Los Angeles, CA 90017
Hingham, MA 02043
FAX: 781-741-3502
PHONE:213-593-6192
PHONE: 781-741-3029
FAX:213-593-5941
FAX: 781-741-3051
Jane Hite
Trace
Woodward
Deidre
Duhart
CIO
Director of Finance
Director of California Beneficiary
NHIC, Corp.
NHIC, Corp.
Services & Provider Outreach &
75 Sgt. William Terry Drive
402 Otterson Drive
Education
Hingham, MA 02043
Chico, CA 95928
NHIC, Corp.
PHONE: 781-741-3401
PHONE: 530-896-7108
1055 West 7th St.
FAX: 781-741-3504
FAX: 530-896-7191
Los Angeles, CA 90017
PHONE: 213-593-6100
Rick Pell
FAX: 213-593-5959
Director of Facilities & Record
Management
NHIC, Corp.
47 Hospital Hill Road
Binghamton, NY 13901
PHONE: 607-648-7660
44
SECTION III - COMMERCIAL AND INDEPENDENTS - PART A & B
NATIONWIDE MUTUAL INSURANCE COMPANY (HOME OFFICE) – See Palmetto GBA, LLC, (
South Carolina)
WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION
PART B JURISDICTION: State of Wisconsin, Illinois, Michigan, and Minnesota
ADMINISTRATION:
STREET
ADDRESS:
P.O. Box 8190
1717 W. Broadway
Madison, Wisconsin 53708
Madison, Wisconsin 53713
PHONE: 608-221-4711
PART B - CONTRACT NO. HCFA 87-032-2
FAX: 608-301-2625
EMAIL: WPS00951@madison.tds.net
EXECUTIVE
James R. Riordan
William
Bathke
Guy
Ringle
Sally
Wood
President & CEO
Executive V. P. and COO
Senior Vice President
Vice President
Medicare Division
Medicare Administration
PHONE: 608-301-2639
PHONE: 608-301-2699
Marie Wybo
David Horst
Lisa Sunde
Shelia Bechman
Vice President Support &
Vice President, Medicare
Director, Training & Quality
Vice President, Medicare
Financial Operations
Operations
Improvement
Systems & Technology
PHONE: 248-395-7701
PHONE: 608-301-2608
PHONE: 608-301-2607
PHONE: 608-301-2618
Susan Porter
Mary Strope
Director
Vice President
Program Compliance
Provider & Beneficiary
PHONE: 608-301-2612
Services
PHONE: 608-301-2605
Wisconsin Claims:
Illinois Claims
Michigan Claims
Minnesota Claims
P.O. Box 1787
P.O. Box 1030
P.O. Box 5555
8120 Penn Avenue South
Madison, Wisconsin 53701
Marion, IL 62959
Marion, IL 62959
Bloomington, MN 55431
1-800-MEDICARE
1-800-MEDICARE
1-800-MEDICARE
1-800-MEDICARE
(Bene.)
(Bene.)
(Bene.)
(Bene.)
45
SECTION IV - DURABLE MEDICAL EQUIPMENT MEDICARE ADMINISTRATIVE
CONTRACTORS (DME MACs) AND REGIONAL HOME HEALTH INTERMEDIARIES
Regional Home Health Intermediaries
Region I(*)
Anthem Health Plans of Maine Inc.
110 Free Street
Portland, Maine 04101-3908
Phone: 207-822-7000
Serving: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
Region IV(*)
Palmetto GBA, LLC
I-20 at Alpine Road
Columbia, South Carolina 29219
Phone: 803-788-3860
Serving: Kentucky, North Carolina, South Carolina, Tennessee, Alabama, Florida, Georgia, Mississippi,
Arkansas, Louisiana, New Mexico, Oklahoma, Texas, Illinois, Indiana, and Ohio
Region V(*)
United Government Services, LLC
401 West Michigan Street
Milwaukee, Wisconsin 53203-2804
PHONE: 414-226-6203
Serving: Alaska, Arizona, California, Hawaii, Idaho, Oregon, Nevada, Washington, Northern Mariana Islands,
Guam, and American Samoa, Michigan, Minnesota, New Jersey, New York, Puerto Rico, the Virgin Islands, and
Wisconsin
*Designates the CMS Region in which the intermediary is physically located.
46
SECTION IV - DURABLE MEDICAL EQUIPMENT MEDICARE ADMIISTRATIVE CONTRACTORS
(DEMMACs) AND REGIONAL HOME HEALTH INTERMEDIARIES
Regional Home Health Intermediaries
Region VII(*)
Blue Cross and Blue Shield of Alabama
P.O. Box 83019
Birmingham, Alabama 35283-0139
Phone: 205-988-2100
Serving: Colorado, Iowa, Kansas, Missouri, Montana, Nebraska, North Dakota, South Dakota, Utah, Wyoming,
Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia
*Designates the CMS Region in which the intermediary is physically located.
47
SECTION IV - DURABLE MEDICAL EQUIPMENT MEDICARE ADMINISTRATIVE
CONTRACTORS (DME MACs) AND REGIONAL HOME HEALTH INTERMEDIARIES
Durable Medical Equipment Medicare Administrative Contractors (DME MACs)
A JURISDICTION
National Heritage Insurance Company
HHSM-500-2006-M0001Z
Anne Bockhoff Dalton
Vice President
75 Sgt. William Terry Drive
Hingham, MA 02043
PHONE: 781-741-3201
FAX: 781-741-3582
Serving: Connecticut, Delaware, District of Columbia, Maine, Massachusetts, Maryland, New Hampshire, New
Jersey, New York, Pennsylvania, Rhode Island, Vermont
B JURISDICTION
AdminaStar Federal Inc.
HHSM-500-2006-M0002Z
Michael McCarron
President
8115 Knue Road
Indianapolis, Indiana 46250
Phone: 317-841-4400
FAX: 317-841-4691
Serving: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin
48
SECTION IV - DURABLE MEDICAL EQUIPMENT MEDICARE ADMINISTRATIVE
CONTRACTORS (DME MACs) AND REGIONAL HOME HEALTH INTERMEDIARIES
C JURISDICTION
DMERC Contract No. HCFA-500-93-BPO-3
Mr. Bruce W. Hughes
President and Chief Operating Officer
Palmetto GBA, LLC
I-20 at Alpine Road
Columbia, South Carolina 29219
Phone: 803-763-7130
FAX: 803-935-0081
Serving: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina,
Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia
CIGNA Government Services
HHSM-500-2006-M0006Z
Mr. Brian Setzer
Vice President
CIGNA Government Services
Two Vantage Way
Nashville, TN 37228
PHONE: 615-782-4618
FAX: 615-782-4695
Serving: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina,
Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia
49
SECTION IV - DURABLE MEDICAL EQUIPMENT MEDICARE ADMINISTRATIVE CONTRACTOR
(DME MACs) AND REGIONAL HOME HEALTH INTERMEDIARIES
Durable Medical Equipment Medicare Administrative Contractor (DME MACs)
D JURISDICTION
Noridian Administrative Services, LLC
HHSM-500-2006-M0004Z
Michael Hamerlik
President & CEO
901 40th St. S
Suite 1
Fargo, ND 58103
Phone: 701-282-1868
FAX: 701-277-5150
Serving: Alaska, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska,
Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, American Samoa and Northern
Mariana Islands
50
SECTION IV - COMMON WORKING FILE HOST CONTRACTORS
Blue Shield of Alabama
First Coast Service Options, Inc.
TrailBlazer Health Enterprises, LLC
51
SECTION IV - RURAL HEALTH CLINICS
Contractor
JURISDICTION
Anthem HealthPlans of Maine Inc.
Maine
Anthem Health Plans of New Hampshire, Inc.
New Hampshire, Vermont
Highmark Inc.
Connecticut, Delaware, District
Of Columbia, New York,
Pennsylvania, Puerto Rico, Rhode
Island, Massachusetts, Virginia
West Virginia, Maryland, New
Jersey, Virgin Islands
TrailBlazer HealthEnteprises, LLC
Colorado, Montana, North Dakota
Oklahoma, South Dakota, Utah,
Wyoming, Texas, Arkansas,
Louisiana, New Mexico
Blue Cross and Blue Shield of Tennessee
Kentucky, Tennessee, North Carolina
South Carolina, Mississippi, Alabama,
Georgia, Florida, Alaska, American
Samoa, Arizona, California, Guam,
Hawaii, Idaho, Illinois, Indiana, Iowa
Kansas, Michigan, Minnesota, Missouri
Nebraska, Nevada, Ohio, Oregon,
Washington, Wisconsin
52
SECTION V – PART A/B MEDICARE ADMINISTRATIVE CONTRACTS
NORTH DAKOTA
Service Area: Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming
Contract Number: HHSM0500-2006-M0005Z
NORIDIAN ADMINISTRATIVE SERVICES, LLC
901 40th Street South, Suite 1
Fargo, ND 58103-2146
Point of Contact: Mr. Ron Laverdure
PHONE: 701-277-5186
FAX: 701-277-5150
53
Document Outline
