OM AdQIC Statement of Work

Attachment J-1 – Statement of Work

RFP 75FCMC26R0054 (AKA RFP 260025J)

ADMINISTRATIVE QUALIFIED INDEPENDENT CONTRACTOR (AdQIC)

TASK ORDER

Attachment J-1 - STATEMENT OF WORK
I.

SCOPE

The contractor shall provide administrative services in support of the Qualified Independent Contractors (QICs) that perform adjudication services in accordance with §1869 of the Social Security Act, as amended by both the Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP) Benefits Improvement and Protection Act (BIPA) of 2000 and the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003. A.

Background

The Administrative QIC (AdQIC) Task Order (TO) includes providing appeals training and coordination, long term case file storage, referrals to the Medicare Appeals Council within the Departmental Appeals Board (herein Appeals Council) and notifying Medicare Administrative Contractors (MACs) to effectuate Administrative Law Judges (ALJ) and Appeals Council decisions.
B.

Purpose

The purpose of the AdQIC is to provide support to each of the QICs and to ensure that, at a minimum, the following functions are performed:
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Collect, consolidate, store, maintain, and distribute information regarding the receipt, processing and disposition of reconsideration and expedited reconsideration requests; Develop, maintain, distribute, and update reconsideration and expedited reconsideration review protocols;
Maintain, distribute and update the QIC Manual;
Review reconsideration and expedited reconsideration data for statistical and analytical purposes, including the production of management information reports, to include trend analysis and recommendations for continuous quality and process improvement; Coordinate and conduct QIC training on all aspects of the reconsideration process; Activities associated with ALJ and Appeals Council hearings, including: - Maintaining the Electronic Notice of Hearing (eNOH) Portal for coordinating contractor participation in hearing and ensuring seamless communication of participating parties from the site to the ALJ;
- Preparation and transfer of case files to the Office of Medicare Hearings and Appeals (OMHA), Appeals Council, or to Federal District Court;

Attachment J-1 – Statement of Work

RFP 75FCMC26R0054 (AKA RFP 260025J)

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Review, analyze, and forward ALJ and Appeals Council effectuation data related to all decisions (i.e., partially favorable, favorable, and/or unfavorable cases that involve