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Medical Affirmative Claims

The Federal Medical Care Recovery Act (FMCRA) authorizes military treatment facilities (MTFs) to recover the cost of furnishing health care to DoD beneficiaries, including active duty members, who are injured or suffer an illness caused by a third party. Medical Affirmative Claims (MAC) is the military program established to accomplish this purpose. MAC activities involve billing all areas of liability insurance, including:

  • Automobile;
  • Homeowners and renters;
  • General casualty;
  • Medical malpractice; and
  • Workers' compensation (for persons other than federal employees).

MAC also includes collecting accrued payments for the lost time of Service members who are injured or suffer an illness caused by a third party. MTF billing offices work with their Service-designated Judge Advocate General (JAG) to submit these claims. 

The rates used for MAC billing are the same as those included in the Inpatient Adjusted Standardized Amounts (ASA) and Outpatient rates packages. These rates, however, must be approved by the Office of Management and Budget and be published in the Federal Register before they can be used for MAC purposes. 

Funds collected through MAC are used to enhance the health care delivery at the MTF providing the care.

To determine which rate file to use for MAC billing, please refer to the DHA UBO MAC Billing Claims Quick Reference Guide.  

CY 2017 Outpatient Rates Approved

On behalf of the DHA UBO Program Office, the CY 2017 Outpatient rates for Medical Affirmative Claims (MAC) billing were approved by the Office of Management and Budget (OMB) and posted in the Federal Registrar. These rates are available for billing for dates of service on or after July 1, 2017. A reference guide and the billing rates are available on the UBO Launchpad site. Feel free to reach out to the UBO Help Desk via email or by calling 1-202-741-1532 and leaving a message. 

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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