CMS Awards Contracts for Second-Level Claims Appeals

Baltimore

CMS has awarded contracts to eight companies to perform second-level appeals of denied fee-for-service Medicare claims.

Part of an overhaul to the Medicare claims appeals system, to be completed by Oct. 1, 2005, the reconsiderations that will be conducted by the eight contractors will replace the current “fair hearing” process for Part B claims in an effort to speed the appeals process. Statute requires that reconsiderations must be completed within 60 days from the day the request is filed.

Companies awarded these contracts, called Qualified Independent Contractors (QICs), include Integriguard LLC, Q2 Administrators (Q2A), Island Peer Review Organization (IPRO), Rivertrust Solutions, Computer Sciences Corp. (CSC), Maximus LLC, First Coast Services Options and Permedion.

The contractors will be able to bid on specific types of appeals workloads, including DME appeals, and in the specific areas of the country for which they will process claims, CMS stated in a press release.

Other changes include developing an appeal-specific data system that allows users to track individual appeals in real time, and finalizing the transfer of responsibility for third-level appeals, conducted by Administrative Law Judges (ALJs), from the Social Security Administration to the Department of Health and Human Services.