Qualified Independent Contractors (QIC)

The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) included provisions aimed at improving the Medicare appeals process.  Part of these provisions mandate that all second-level appeals, also known as reconsiderations, be conducted by Qualified Independent Contractors (QICs ).  These provisions require that QICs utilize a comprehensive data system to collect and share information about appeals decisions, give weight to carrier and fiscal intermedicary local coverage determinations, and conduct a panel review of all medical necessity denials.

The reconsiderations that will be conducted by the QICs will replace the Hearing Officer Hearing process for Medicare Part B claims and establish a new second level of appeal for Medicare Part A claims. CMS awarded contracts to eight Qualified Independent Contractors (QICs) to perform reconsiderations of denied Medicare fee-for-service claims.




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