IntegriGuard Awarded Federal Designation as Qualified Independent Contractor

October 12, 2004
Contact: Diana Parker
415.677.2122
dlparker@caqio.sdps.org

OMAHA, NE. October 12, 2004 - IntegriGuard, LLC, federally designated both as a Program Safeguard Contractor (PSC) and a Medicare Managed Care Program Integrity Contractor (MMC-PIC) for the Centers for Medicare & Medicaid Services' (CMS) Medicare Integrity Program, has been awarded a third federal designation as a Qualified Independent Contractor (QIC). As one of eight companies to receive this highly sought after new designation, IntegriGuard is now eligible to competitively bid on Medicare claim reconsideration review work.

The Social Security Act (SSA), Sections 1869 and 1879, entitles Medicare beneficiaries and providers the right to appeal adverse determinations of Medicare Part A and B claims. Currently, several entities, such as Medicare carriers and fiscal intermediaries, are involved in the Medicare administrative appeal process.

The Benefits Improvement, and Protection Act of 2000, modified by the Medicare Modernization Act of 2003, created the QIC designation and substantially changed the Medicare appeals process by revising time limits for filing appeals, reducing the timeframe for decision-making, and establishing the right to an expedited reconsideration determination.

The overall goal of the mandated changes is to improve the efficiency and accuracy of reconsiderations, as well as decrease the appeals processing time. Additionally, IntegriGuard's future workload may include appeals under the Medicare Advantage (formerly Medicare + Choice) Program and appeals related to any Medicare prescription drug benefit (Medicare Part D).

Other duties of a QIC include the identification of trends and educational needs for beneficiaries and providers related to the appeals process.

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About IntegriGuard

Omaha, Nebraska-based IntegriGuard was formed in 1999. Formerly a division of Lumetra, California's Quality Improvement Organization for Medicare (QIO), IntegriGuard became IntegriGuard LLC, an independent entity, on April 1, 2003. In addition to being designated by the Centers for Medicare & Medicaid Services (CMS) as one of eight Qualified Independent Contractors (QICs), IntegriGuard is one of twelve federally-designated Program Safeguard Contractors (PSC) and one of eight federally-designated Medicare Managed Care Program Integrity Contractors (MMC-PIC) for CMS' Medicare Integrity Program (MIP).