Tricenturion

TriCenturion is a Program Safeguard Contractor (PSC) under contract with the Centers for Medicare & Medicaid Services (CMS) to perform selected Medicare program integrity tasks.

Effective March 1, 2008, the medical review (MR) not for benefit integrity (BI) functions that were the responsibility of the DME Program Safeguard Contractors (PSCs) are now transitioned to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) for all DME MAC Jurisdictions.  Due to the transition, the DME MACs have assumed full responsibility of the following workload (including policies previously found on this site): 

•         Performance of MR not for BI functions as outlined in MLN Matters article 5765 and the Medicare Program Integrity Manual (PIM), Chapter 5 – Items and Services Having Special DME Review Considerations;

•         Comprehensive Error Rate Testing (CERT);

•         Local Coverage Determinations (LCDs)

•         Advance Determination of Medicare Coverage (ADMC);

•         Healthcare Common Procedure Coding System (HCPCS);

•         Medical Review not for BI Claim Edits;

•         Probe Reviews;

•         Supplier Education and

•         Medical Review of Claims (not for BI purposes)

Additional information for Jurisdiction A can be obtained through the NHIC DME MAC Web site at: http://www.medicarenhic.com/dme

Additional information for Jurisdiction B can be obtained through the NGS DME MAC Web site at: http://www.NGSMedicare.com