Review and Appeals
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    Complaints and Appeals

    Medicare has mandated a new process for handling Medicare beneficiaries' quality-of-care complaints, discharge appeals, and other medical case reviews formerly managed by Qualis Health.

    The new QIO Program structure designates Beneficiary and Family-Centered Care QIOs (BFCC-QIOs) to perform these services. As of August 1, 2014, the BFCC-QIO for Idaho and Washington is Livanta.

    Patients and Families:

    If you wish to file a complaint related to the quality or necessity of care provided, and that care was covered by Medicare, please contact:

    • For care received in Idaho or Washington, call Livanta at 1-877-588-1123 (TTY: 1-855-887-6668)
       
    • For care provided elsewhere, call 1-800-MEDICARE (1-800-633-4227)

    If you are a patient with Medicare coverage and have been notified that your medical services are about to end—and you believe that you still need these services, you can begin the discharge appeal process by contacting:

    • For care received in Idaho or Washington, call Livanta at 1-877-588-1123 (TTY: 1-855-887-6668)
       
    • For care received elsewhere, call 1-800-MEDICARE (1-800-633-4227)

    It is important to begin the appeal process quickly. You may leave a message at any time, on any day. Be sure to provide:

    1. The patient’s name and Social Security number
       
    2. The name of the healthcare facility
       
    3. The type of notice you received (such as Notice of Medicare Provider Non-Coverage, Hospital-Issued Notice of Non-Coverage, An Important Message From Medicare About Your Rights ) and the date, according to the notice, that your services will end
       
    4. A phone number where you can be reached

    Idaho and Washington's
    Healthcare Organizations and Providers:

    Please see Livanta's website for details about any of the following requirements and for the latest announcements.

    All beneficiary notices must provide Livanta’s (not Qualis Health's) contact information. Any notice that fails to contain Livanta’s contact information may result in the technical denial of a case.

    Examples of notices that need to be updated include:

    • Notice of Medicare Non-Coverage (NOMNC)
    • Important Message from Medicare
    • Hospital-Issued Notices of Non-Coverage

    Please go to the CMS website to view the most current, approved notices and usage instructions.

    Hospitals are also required to sign an updated Memorandum of Agreement (MOA) with Livanta and comply with Livanta's Physician Attestation/Acknowledgement Monitoring requests.

    Download a printer-friendly bulletin outlining these changes.