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RiverTrust Gets $19 Million Contract for Second-Level DME Appeals
Oct 16, 2006 12:33 PM
CHATTANOOGA, Tenn.--BlueCross BlueShield of Tennessee announced Wednesday that its subsidiary RiverTrust Solutions has been awarded a three-year contract to process second-level appeals for CMS.
As a Qualified Independent Contractor for CMS, RiverTrust will serve as an independent reviewer of appeals for Medicare claims issued by the DME Medicare Administrative Contractors. RiverTrust will handle an anticipated 100,000 DME appeals for the entire country annually. The contract is valued at $19 million.
Traditionally, the DME carriers have handled the first- and second-level appeals process for Medicare. Under the Medicare Modernization Act of 2003, QICs replaced these entities for second-level appeals. The new appeals process also revises the time limits for filing appeals and reduces the decision-making timeframe. As part of the new appeals structure, QICs also are required to identify trends and the educational needs for providers and beneficiaries as they relate to the appeals process.
BlueCross BlueShield of Tennessee created its RiverTrust subsidiary to bid on Medicare QIC contracts. RiverTrust is one of only eight organizations designated as an Indefinite Delivery Indefinite Quantity contractor. By qualifying as an IDIQ contractor, RiverTrust is able to bid on QIC business as it is released by CMS.
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