Quality Improvement Organization (QIO) Review of Part C Provider Terminations

When a Medicare health plan, either directly or by delegation, terminates pre-authorized coverage of an inpatient hospital admission or Skilled Nursing Facility (SNF), Home Health Agency (HHA), or Comprehensive Outpatient Rehabilitation Facility (CORF) services, 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 Quality Improvement Organization (QIO) performs the review.

For instructions on how to file for a QIO review, health plan enrollees should check their provider termination notice; or they may call 1-800-MEDICARE to find out how to contact their local QIO.

For detailed guidance, click on the documents in the "Downloads" section below.

For copies of the related notices and forms, click on the "Notices and Forms" link on the left side of this page. 

How Late Requests Are Handled

If the deadline for requesting a QIO review is missed, the enrollee or his or her representative may still ask the health plan for an expedited appeal. 

For more information, please see the materials in the "Downloads" section below.  Also, health plan enrollees may see the plan's Evidence of Coverage, or call the plan or 1-800-MEDICARE to find out how to contact their local QIO.