RiverTrust Gets $19 Million Contract for Second-Level DME Appeals

CHATTANOOGA, Tenn.–BlueCross BlueShield of Tennessee announced
Wednesday that its subsidiary RiverTrust Solutions has been awarded
a three-year contract to process second-level appeals for CMS.

As a Qualified Independent Contractor for CMS, RiverTrust will
serve as an independent reviewer of appeals for Medicare claims
issued by the DME Medicare Administrative Contractors. RiverTrust
will handle an anticipated 100,000 DME appeals for the entire
country annually. The contract is valued at $19 million.

Traditionally, the DME carriers have handled the first- and
second-level appeals process for Medicare. Under the Medicare
Modernization Act of 2003, QICs replaced these entities for
second-level appeals. The new appeals process also revises the time
limits for filing appeals and reduces the decision-making
timeframe. As part of the new appeals structure, QICs also are
required to identify trends and the educational needs for providers
and beneficiaries as they relate to the appeals process.

BlueCross BlueShield of Tennessee created its RiverTrust
subsidiary to bid on Medicare QIC contracts. RiverTrust is one of
only eight organizations designated as an Indefinite Delivery
Indefinite Quantity contractor. By qualifying as an IDIQ
contractor, RiverTrust is able to bid on QIC business as it is
released by CMS.