Effective June 8, 2019, Centers for Medicare & Medicaid Services (CMS) restructured the BFCC-QIO coverage.

Sharon Hamilton MS, RN, CFDS
Clinical Consultant, Briggs Healthcare

When a Medicare health plan, either directly or by delegation, terminates pre-authorized coverage of services from a Home Health Agency (HHA) a special expedited review procedure applies. Expedited review requests filed timely bypass the health plan’s reconsideration process, and an independent review entity known as a Beneficiary Family Centered Care-Quality Improvement Organization (BFCC-QIO) performs the review.

CMS restructured the BFCC-QIO coverage and created 10 Regions across the United States. Beginning June 8, 2019, KEPRO will be responsible for Regions 1,4,6,8, and 10. Livanta will be responsible for Regions 2,3,5,7, and 9.

What should your agency do now? Update your Notice of Medicare Non-coverage (NOMNC) with the correct BFCC-QIO phone number for your Region.

KEPRO will cover –

Region 1 (CT, MA, ME, NH, RI, VT)1-888-319-8452

Region 4 (AL, FL, GA, KY, MS, NC, SC, TN) 1-888-317-0751

Region 6 (AR, LA, NM, OK, TX) 1-888-315-0636

Region 8 (CO, MT, ND, SD, UT, WY)1-888-317-0891

Region 10 (AK, ID, OR, WA) 1-888-305-6759

https://www.keproqio.com/media/1312/faq_bfcc-qio_2019_transition_finalv508.pdf

Livanta will cover –

Region 2 (NY, NJ, PR, VI): 1-866-815-5440,

Region 3 (PA, MD, DE, DC, VA, WV): 1-888-396-4646

Region 5 (OH, IN, IL, MI, MN, WI): -888-524-9900

Region 7 (IA, MO, KS, NE): 1-888-755-5580

Region 9 (CA, AZ, NV, HI, GU, CN, AS):

https://www.whcawical.org/files/2019/05/BFCC-QIO-Livanta-Transition-Provider-Bulletin_05132019.pdf