QUALIFIED INDEPENDENT CONTRACTOR (QIC) PART A EAST JURISDICTION

This posting provides notice that the limited-sources justification (LSJ) for the Qualified Independent Contractor (QIC) Part A East Jurisdiction procurement being posted pursuant to FAR 8.405-6(a)(2), which requires the ordering activity to publish a notice and post the justification within 14 days after placing an order exceeding the simplified acquisition threshold that is supported by an LSJ.

The QIC is responsible for all reconsiderations requested as a result of Medicare Administrative Contractors (MACs) redeterminations of Medicare Part A and Part B of A claims. This workload includes processing reconsideration requests for, at a minimum, hospital inpatient, home health, skilled nursing home, hospice, and other Part A services and claims. It also includes institutional claims which are paid from the Part B Trust Fund (sometimes referred to as “Part B of A”). The QIC shall also be responsible for the expedited reconsideration workload comprised of, at a minimum, service termination and hospital discharge reviews performed by Quality Improvement Organizations (QIOs). It shall be noted that the QIC is also responsible for reconsiderations based on “initial determinations” regarding Medicare Secondary Payer (MSP) recovery claims against beneficiaries or providers/suppliers where the redetermination was processed by a MAC. Such recovery claims against beneficiaries routinely include both Part A & Part B claims.