PARTICIPATING PAYERS AND CONTRACTORS

COMMERCIAL

Cal Medi Connect CHAMPVA – HAC FFS Prior Quarter FFS Regular
FFS Temporary
Federal Emergency Services Program (FESP) Hospital Presumptive Eligibility (HPE)
L.A. Care Covered
MediCal (Los Angeles County)
PacificSource
PASC-SEIU Plan
The American Indian Health Program (AIHP) Tribal Regional Behavioral Health Author Tribal ALTCS
VA Fee Basis Programs
UniCare

BLUE

California – Anthem Blue Cross
California – Anthem Blue Cross FEP
Colorado – Anthem Blue Cross and Blue Shield
Nevada – Anthem Blue Cross and Blue Shield

MEDICARE/MEDICAID

California – Anthem Blue Cross Medi-Cal
California – Anthem Blue Cross Healthy Families California – ACS Medi-Cal
West Virginia – UniCare Health Plan of West Virgilnia Inc.

RECOVERY AUDIT CONTRACTORS

  1. RAC Region 1 (Performant Recovery)
  2. RAC Region 2 (Cotiviti)
  3. RAC Region 3 (Cotiviti)
  4. RAC Region 4 (HMS Federal Solutions)
  5. RAC Region 5 (Performant Recovery, DME)

MEDICARE ADMINISTRATIVE CONTRACTORS

MAC JE (Noridian)

MAC JF (Noridian)

MAC JH (Novitas Solutions)

MAC J5 (WPS)

MAC JM (Palmetto)

MAC JL (Novitas Solutions)

MAC JK (NGS)

MAC JN (First Coast)

MAC JJ (Palmetto)

MAC J15 (CGS)

MAC J6 (NGS)

MAC J8 (WPS)

Comprehensive Error Rate Testing – CERT (AdvanceMed)

Program Error Rate Measurement – PERM (CNI, Cycle 1)

Program Error Rate Measurement – PERM (AdvanceMed)

Supplemental Medical Review Contractor – SMRC (Noridian)

Railroad Retirement Board – RRB (Palmetto)

MEDICARE ADMINISTRATIVE CONTRACTORS (DURABLE MEDICAL EQUIPMENT)

DME MAC A (Noridian)

DME MAC D (Noridian)

DME MAC B (CGS)

DME MAC C (CGS)

UNIFIED PROGRAM INTEGRITY CONTRACTOR

UPIC North-Eastern (Safeguard Services)

UPIC Mid-West (AdvanceMed)

UPIC South-West (Qlarant)

UPIC South-East (Safeguard Services)

UPIC West (Qlarant)

QUALITY IMPROVEMENT ORGANIZATIONS

QIC Part A – West (Maximus)

QIC Part A – East (C2C Solutions)

QIC Part B – North (C2C Solutions)

QIC Part B – South (C2C Solutions)

QIC DME (C2C Solutions)

QIO Appeals (Livanta)

QIO Quality of Care Complaints (Livanta)

QIO Higher-Weighted Diagnosis (Livanta)

QIO Short Stay Reviews (Livanta)

QIO BFCC (Avar)

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