[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR421.210]

[Page 824-826]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 421--INTERMEDIARIES AND CARRIERS--Table of Contents
 
                           Subpart C--Carriers
 
Sec. 421.210  Designations of regional carriers to process claims for durable medical equipment, prosthetics, orthotics and supplies.

    (a) Basis. This section is based on sections 1834(a) and 1834(h) of 
the Act which authorize the Secretary to designate one or more carriers 
by specific regions to process claims for durable medical equipment, 
prosthetic devices, prosthetics, orthotics and other supplies (DMEPOS). 
This authority has been delegated to CMS.
    (b) Types of claims. Claims for the following, except for items 
incident to a

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physician's professional service as defined in Sec. 410.26, incident to 
a physician's service in a rural health clinic as defined in 
Sec. 405.2413, or bundled into payment to a provider, ambulatory 
surgical center, or other facility, are processed by the designated 
carrier for its designated region and not by other carriers--
    (1) Durable medical equipment (and related supplies) as defined in 
section 1861(n) of the Act;
    (2) Prosthetic devices (and related supplies) as described in 
section 1861(s)(8) of the Act, (including intraocular lenses and 
parenteral and enteral nutrients, supplies, and equipment, when 
furnished under the prosthetic device benefit);
    (3) Orthotics and prosthetics (and related supplies) as described in 
section 1861(s)(9);
    (4) Home dialysis supplies and equipment as described in section 
1861(s)(2)(F);
    (5) Surgical dressings and other devices as described in section 
1861(s)(5);
    (6) Immunosuppressive drugs as described in section 1861(s)(2)(J); 
and
    (7) Other items or services which are designated by CMS.
    (c) Region designation. The boundaries of the four regions for 
processing claims described in paragraph (b) of this section coincide 
with the boundaries of 1 or more sectors or areas designated for the 
Common Working File. These four regions contain the following States and 
territories: Region A: Maine, New Hampshire, Vermont, Massachusetts, 
Connecticut, Rhode Island, New York, New Jersey, Pennsylvania, and 
Delaware. Region B: Maryland, the District of Columbia, Virginia, West 
Virginia, Ohio, Michigan, Indiana, Illinois, Wiconsin and Minnesota. 
Region C: North Carolina, South Carolina, Kentucky, Tennessee, Georgia, 
Florida, Alabama, Mississippi, Louisiana, Texas, Arkansas, Oklahoma, New 
Mexico, Colorado, Puerto Rico and the Virgin Islands. Region D: Alaska, 
Hawaii, American Samoa, Guam, the Northern Mariana Islands, California, 
Nevada, Arizona, Washington, Oregon, Montana, Idaho, Utah, Wyoming, 
North Dakota, South Dakota, Nebraska, Kansas, Iowa and Missouri.
    (d) Criteria for designating regional carriers. CMS designates 
regional carriers to achieve a greater degree of effectiveness and 
efficiency in the administration of the Medicare program as measured by-
-
    (1) Timeliness of claim processing;
    (2) Cost per claim;
    (3) Claim processing quality;
    (4) Experience in claim processing, and in establishing local 
medical review policy; and
    (5) Other criteria that CMS believes to be pertinent.
    (e) Carrier designation. (1) Each carrier designated a regional 
carrier is responsible, using the payment rates applicable for the State 
of residence of a beneficiary, including a qualified Railroad Retirement 
beneficiary, for processing claims for items listed in paragraph (b) of 
this section for beneficiaries whose permanent residence is within the 
area designated in paragraph (c) of this section. A beneficiary's 
permanent residence is the address at which he or she intends to spend 6 
months or more of the calendar year.
    (2) The regional carriers designated to process DMEPOS claims (as 
defined in paragraph (b) of this section) for all Medicare beneficiaries 
residing in their respective regions (as designated in paragraph (c) of 
this section), including those entitled under the Railroad Retirement 
Act, are the following:
    (i) The Travelers Insurance Company (Region A), which will be 
processing claims in Pennsylvania.
    (ii) Associated Insurance Companies, Inc.--AdminaStar (Region B), 
which will be processing claims in Indiana.
    (iii) Blue Cross and Blue Shield of South Carolina (doing business 
as Palmetto Governments Benefits Administrators) (Region C), which will 
be processing claims in South Carolina.
    (iv) Connecticut General Life Insurance Co. (a CIGNA Company) 
(Region D), which will be processing claims in Tennessee.
    (3) Blue Cross and Blue Shield of South Carolina (Palmetto 
Government Benefits Administrators) has been selected to serve as the 
National Supplier Clearinghouse and the Statistical Analysis DME 
regional carrier.

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    (4) The contracts for the four DME regional carriers will be 
periodically recompeted. The National Supplier Clearinghouse and 
Statistical Analysis DME regional carrier do not constitute separate 
contracts, but are contract amendments to one of the DME regional 
carrier contracts. The National Supplier Clearinghouse and Statistical 
Analysis DME regional carrier contract amendments will also be 
periodically recompeted.
    (f) Collecting information of ownership. Carriers designated as 
regional claims processors must obtain from each supplier of items 
listed in paragraph (b) of this section information concerning ownership 
and control as required by section 1124A of the Act and part 420 of this 
chapter, and certifications that supplier standards are met as required 
by part 424 of this chapter.

[57 FR 27307, June 18, 1992, as amended at 58 FR 60796, Nov. 18, 1993]