Coding Tip: File Your DME Claims to the Correct DME MAC

Electronic claim submission can be tedious. Check out our latest coding tip to help you stay efficient in your claim filing processes!

When filing a Medicare claim to a Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) for spectacle lenses after a recent cataract surgery, the claim must then be processed by the DME MAC whose jurisdiction covers the state where the beneficiary currently resides. This remains true even if you are located in a different jurisdiction. DME claims are processed solely based on the address of the beneficiary, and not the location where the item/service is being rendered. If the claim is recieved with an address listed outisde of the DME MAC's jurisdiction (based on Medicare records), the claim will be denied.

We have some tips that can help you avoid receiving denials related to the beneficiary's address:

• Confirm the address of the beneficiary before filing the claim.
• Ask if the beneficiary has more than one address, and if so, ask which one is currently on file with Medicare/Social Security.
• File the claim promptly. Waiting months to file the claim can give the beneficiary time to change addresses since the item/service was rendered.
• If the beneficiary has recently had a change of address, make sure they are aware to inform Medicare/Social Security of this change.