Qualified Independent Contractor

Indefinite Delivery / Indefinite Quantity

IntegriGuard is one of eight companies nationwide that has been designated as a Qualified Independent Contractor (QIC) from the Centers for Medicare & Medicaid Services (CMS). As a QIC, IntegriGuard is eligible to competitively bid on Medicare claim reconsideration review work.

The Social Security Act, 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. In addition, 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.