Trailblazer Medicare - An Explanation

Understanding Trailblazer Medicare

What is Trailblazer?

Trailblazer Medicare is contracted to provide a variety of benefits through prior arrangement with the Centers for Medicare and Medicaid Services, also known as CMS.

Trailblazer Services provides a variety of functions, including acting as intermediaries for the Veterans Affairs Claims Recovery Project. In addition to offering both Part A and Part B Medicare processing, Trailblazer provides reimbursement and coverage for skilled nursing facility chains and dialysis centers in the central southwest, as well as acting as a regional processor for a variety of rural health clinics in the central U.S.

Trailblazer Medicare Services also offers claims services for end-stage renal disease for individuals living in Colorado, New Mexico, Louisiana and Arkansas.Trailblazer Health Enterprises, LLC serves as a Medicare administrative contractor, (also known as MEC) for a variety of jurisdictions found throughout the United States, including jurisdictions Four and Seven. Jurisdiction Four is comprised of Oklahoma, Colorado, New Mexico and Texas. Jurisdiction Seven includes Louisiana, Mississippi, and Arkansas. Trailblazer Medicare Services also cover billing and claims processing for Indian Health Services.

Medicare administrative contracts with Centers for Medicare and Medicaid Services in claims payment, enrollment, audit activities and customer service. Altogether, fifteen Medicare administrative contractors operate nationally for the Medicare fee-for-service program.

trailblazer medicare

Trailblazer Company

Trailblazer services have been offered to regional citizens for over five decades, and acts as an intermediary and carrier as one of Medicare's largest contractors. Since the mid -1960s, Trailblazer has offered Part A and Part B billing contracts to Medicare programs and covers a wide range of service areas and specialties.

Trailblazer is based in Dallas, Texas with operational offices and field audit offices located in other cities in Texas, providing claims services, customer service and program administration operations.Customer service for Trailblazer depends on the area and type of coverage offered, including:

  • Indian Health customer services
  • Medicare Parts A and Part B for region J4 customer service, which applies to Oklahoma, Texas, New Mexico and Colorado.
  • Medicare Part B services in VirginiaServices provided for Part A include but are not limited to:
  • Patient benefits and eligibility
  • Managed care enrollment
  • Medicare secondary payer enrollment
  • Claims status
  • Appeal status

In 2008 alone, Trailblazer processed over one hundred million Medicare claims, and made more than $20 billion in payments to physicians, skilled nursing facilities, hospitals, ambulance service providers, home health agencies, and other care facilities and contractors.

Additional Services

Trailblazer Health also offers a variety of services in claims processing, including policies, advice regarding computerized software and technologies in fields of health information management, claims, and billing processing, as well as quality initiatives, advice regarding provider enrollment, and in performing continual audits in reimbursements to beneficiaries.

Trailblazer Audit Tools

Trailblazer helps streamline and create efficiency and accuracy in medical documentation and billing for each encounter by patients with medical care providers. The software enables accurate and efficient coding as well as electronic medical record capabilities for patient history, exams and medical decision-making processes.

In addition, the software creates subdivisions of the medical decision-making process to help with coding and billing in the number of diagnosing methodologies or number of treatments offered, as well as including information regarding risk of morbidity, mortality, or complications. This audit tool helps prevent mistakes in coding and billing to ensure accurate submission and reimbursement of claims.


As a Medicare Part A and Part B processor, Trailblazer Health strives to provide medical providers and patients with faster service, efficient and accurate medical documentation, recording and submission for payments that benefit physicians, health care facilities, and patients.

Consistent updates to systems ensures appropriate coding, billing and payments in the regions where Trailblazer has been charged with the responsibility of processing Medicare claims. Providing valuable support services for CMS, Trailblazer has and continues to provide valuable services to regions throughout the United States. 

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