Who processes the claims for Medicare and Medicaid?

[NNN0LHI]

Do we have a government employees doing this? Or is it someone else?

Anyone know?

Don

[Recursion]

1. Ross Perot's old company used to

That's how he got rich. No idea who has the contract now.

[ProgressiveProfessor]

8. EDS was big and Perot rich before EDS won some of the processing contracts

[Ms. Toad]

2. Some are directly administered by (private) insurance companies.

Both Medicaid and Medicare offer (or mandate) private insurance options with the premium paid by the government. The claims processing is done by the insurance company.

[marybourg]

3. My claims (in regular Medicare, not Medicare Advantage) are processed by

a private contractor to Medicare.

[pipoman]

4. Processors for medicare

are private contractors and differ from one region to another. In my region medicare is administered by Wisconsin Physicians Services (WPS), they administer several states. Medicaid is administered by each state so some states may administer their own medicaid claims and others may contract.

[pinto]

5. In CA (Medicare A & B) it's Palmetto GBA, a subsidiary of Blue Cross / Blue Shield.

Palmetto GBA administers Medicare health insurance for the Centers for Medicare & Medicaid Services (CMS). We have been a Medicare contractor since the inception of the program in 1966 and provide service throughout the United States and its territories. Palmetto GBA is a wholly owned subsidiary of BlueCross BlueShield of South Carolina and is based in Columbia, South Carolina.

http://www.palmettogba.com/palmetto/palmetto.nsf/DocsCat/Home

[cbdo2007]

6. Many of the Medicaid and Medicare plans in Missouri are processed and managed by BCBSKC.

a private insurance company.

[Cleita]

7. A lot of them are processed by the insurance industry.

We were getting bills processed by Blue Cross at one time. I don't know if the present company doing it CMS is the government or a sub-contractor.