You may deal with a fiscal intermediary when accessing some government-subsidized services, such as health services like Medicare or Medicaid. If you're in this position, it's natural to wonder what a fiscal intermediary is and how these organizations work.
A fiscal intermediary is a business contracted by the federal government to administer a program and process its payments in a specific geographic location, such as a metro area or a state. These businesses are usually private companies that work in the insurance industry.
The Office of Insurance Regulation regulates fiscal intermediaries and sets the requirements for registration. Once a fiscal intermediary is authorized, they can partner with government programs such as Medicare and Medicaid.
Join our email series to receive your free Medicare guide and the latest information about Medicare and Medicare Advantage.
By clicking "Sign me up!” you are agreeing to receive emails from MedicareAdvantage.com.
Speak with a licensed insurance agent
Fiscal intermediaries play an essential role in communicating and processing payments on behalf of the government and the people and businesses who use their programs. They can perform several functions, including:
A Medicare Administrative Contractor (MAC) is a type of fiscal intermediary that works with the Medicare program.
After the passing of the Medicare Prescription Drug Improvement and Modernization Act of 2003, the Centers for Medicare and Medicaid Services (CMS) replaced its Part A fiscal intermediaries and Part B carriers with MACs who perform all the duties of fiscal intermediaries.
These private health care insurance companies can process:
A network of MACs serves as the primary contact point between the Medicare FFS program and health care providers across the country. While fiscal intermediaries working with Medicare are now called MACs, those working with Medicaid are still called fiscal intermediaries, or FIs for short.
The federal government contracts with a selection of MACs, or Medicare intermediaries, to administer its Medicare program in districts across the country.
As of December 2020, the approved Medicare intermediaries for Parts A & B claims and the states and territories they work in are:
Note that there is some overlap as MACs have jurisdiction over a set geographical area, which is often smaller than an entire state.
As of December 2020, the approved Medicare intermediaries for home health and hospice claims and the states and territories they work in are:
You might have a relationship with a fiscal intermediary if you have a personal or home care assistant subsidized by Medicaid. You might also work with a fiscal intermediary if one of these assistants cares for your parents or other loved ones. Working with a fiscal intermediary can give you greater control over the care you or a relative receives.
Working with a fiscal intermediary allows you to do the following:
Unlike fiscal intermediaries working with Medicaid, MACs usually communicate more with health care providers than members of the public. Most Medicare beneficiaries don't have relationships with MACs, although a MAC may approve subsidies for your services without you ever knowing.
Depending on where you live, you may have access to Medicare Advantage plans and Medicare Part D prescription drug coverage that meet many of your health care needs. To learn more about what types of plans, benefits, coverage and costs are available in your area, call today to speak with a licensed insurance agent.
You can also compare plans online for free from your home, with no obligation to enroll.
Compare Medicare plans in your areaCompare Plans
Or call TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
Zia Sherrell is a digital health journalist with over a decade of healthcare experience, a bachelor’s degree in science from the University of Leeds and a master’s degree in public health from the University of Manchester. Her work has appeared in Netdoctor, Medical News Today, Healthline, Business Insider, Cosmopolitan, Yahoo, Harper's Bazaar, Men's Health and more.
When she’s not typing madly, Zia enjoys traveling and chasing after her dogs.