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CMS NAMES NEW APPEALS CONTRACTORS

Published on Mon Mar 21, 2005

If you're wondering who will be handling your home health agency and hospice claims appeals, you now have an answer.

The Centers for Medicare & Medicaid Services has named the two qualified independent contractors (QICs) that will handle second-level appeals for HHAs, hospices and other Part A providers.

First Coast Service Options Inc. will handle appeals for the Western half of the country, and Maximus will process appeals for the Eastern half. Reston, VA-based Maximus will receive $20 million for the three-year QIC contract, it says in a March press release.

According to a Medlearn Matters article revised April 12, the East QIC jurisdiction includes Colorado, New Mexico, Texas, Oklahoma, Arkansas, Louisiana, Mississippi, Alabama, Georgia, Florida, Tennessee, South Carolina, North Carolina, Virginia, West Virginia, Puerto Rico, Virgin Islands, Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New Jersey, New York, Delaware, Maryland, Pennsylvania and Washington DC.

The West QIC jurisdiction covers Washington, Idaho, Montana, North Dakota, South Dakota, Iowa, Missouri, Kansas, Nebraska, Wyoming, Utah, Arizona, Nevada, California, Alaska, Hawaii, Oregon, Kentucky, Ohio, Indiana, Illinois, Minnesota, Michigan, Wisconsin, Guam, Northern Mariana Islands and American Samoa.

CMS hasn't yet designated the four QICs that will handle Part B claims starting in January.

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