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
