RiverTrust to hear DME appeals

Sunday, October 15, 2006

CHATTANOOGA, Tenn. - RiverTrust Solutions, a subsidiary of BlueCross BlueShield of Tennessee, has been awarded a three-year contract to process second-level appeals for CMS. The contract is valued at $19 million.

As a Qualified Independent Contractor (QIC) for CMS, RiverTrust will serve as an independent reviewer of appeals for Medicare claims issued by the DME Medicare Administrative Contractors (MACs). RiverTrust will handle an anticipated 100,000 DME appeals nationwide each year.

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 time frame. As part of the new appeals structure, QICs are also 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 (IDIQ) contractor. By qualifying as an IDIQ contractor, RiverTrust is able to bid on QIC business for CMS.