Glossary / Jurisdiction
Jurisdiction Medicare DME termJurisdiction
Which of the four DME MAC regions (A, B, C, or D) a claim belongs to, set by the beneficiary's permanent address on file with Social Security.
In DME billing, jurisdiction means which of the four DME MAC regions processes the claim. It is determined by the beneficiary's permanent address on file with the Social Security Administration, which is the address you report in Item 5 of the CMS-1500 or the equivalent electronic field. A claim sent to the wrong jurisdiction is denied.
Jurisdiction A (Noridian): CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI, VT. Jurisdiction B (CGS): IL, IN, KY, MI, MN, OH, WI. Jurisdiction C (CGS): AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV, Puerto Rico, and the U.S. Virgin Islands. Jurisdiction D (Noridian): AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY, American Samoa, Guam, and the Northern Mariana Islands.
Jurisdiction also decides where your prior authorization request goes, which portal you use, and whose ADRs and reviews you answer. The prior authorization exemption is calculated per PTAN and jurisdiction, so a supplier serving patients in two regions has two separate exemption standings. When a patient moves, the claim follows the updated SSA address, so a stale address is a common source of denials.
Common questions
The patient lives in one state and the supplier is in another. Which MAC?
The patient's. Jurisdiction follows the beneficiary's permanent address, not the supplier's.
What if the patient is at a temporary address for the season?
The SSA permanent address still controls. If the patient has actually moved, they need to update the address with SSA before claims will route correctly.
Do I have to look up the jurisdiction myself?
AffirmDME resolves the jurisdiction and MAC from the beneficiary's address on the case and scopes the readiness checklist to it.
Related
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Sources: Noridian JD DME: Claim denials for incorrect jurisdiction · CMS: MACs by state . Definitions summarize public Medicare policy and are not legal or billing advice.
More terms
- ADR — Additional Documentation Request
- Prior authorization
- Affirmation and non-affirmation
- UTN — Unique Tracking Number
- SWO — Standard Written Order
- Face-to-face encounter
- DME MAC — Durable Medical Equipment Medicare Administrative Contractor
- PTAN — Provider Transaction Access Number
- NPI — National Provider Identifier
- MBI — Medicare Beneficiary Identifier
- LCD — Local Coverage Determination
- NCD — National Coverage Determination
- Policy article
- HCPCS — Healthcare Common Procedure Coding System
- Length of need
- Prior authorization exemption
- Competitive bidding
- CMN and DIF — Certificate of Medical Necessity and DME Information Form
- Proof of delivery
- TPE — Targeted Probe and Educate
- Prepayment review