QIC RFI Technical Questions_2026_2027.xlsx

XLSX spreadsheet 14 KB Posted Oct 19, 2026

Attached to: Request for Information - CMS' Qualified Independent Contractor (QIC) Program
Solicitation number: RFICMSQIC2026
Issued by: Department of Health and Human Services Centers for Medicare and Medicaid Services

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Written by GovTribe AI · Oct 19, 2026

This is a technical questions workbook for the Centers for Medicare and Medicaid Services (CMS) Request for Information (RFI) regarding the Qualified Independent Contractor (QIC) program, solicitation number RFICMSQIC2026, with responses due November 5, 2026. The document comprises three primary sections of inquiry: Programmatic and Operational Questions, Conflict of Interest Focused Questions, and Relevant Experience and Capability questions. Respondents must identify which QIC Lines of Business they can support (Original Medicare Parts A and B, Durable Medical Equipment, Medicare Part C, and Medicare Part D), describe barriers to participation, assess their interest in a potential geographic division of the Part C Line of Business, and provide detailed experience with Medicare claims, compliance reviews, organization determinations, and appeals processes. The RFI also seeks feedback on operational challenges and recommendations for QIC program improvement.

The Conflict of Interest section requires organizations to disclose existing, potential, or perceived conflicts that could impair performance under the IDIQ contract and explain mitigation strategies aligned with QIC COI requirements outlined in RFI attachments. The Relevant Experience section contains 18 detailed capability inquiries organized into four subsections: Operational Infrastructure and Administrative Support (questions 4.3.1-4.3.7), Reconsideration and Appeals Operations (4.3.8-4.3.11), Clinical, Technical, and Professional Capability (4.3.12-4.3.15), and Appeals Coordination and Program Integrity (4.3.16-4.3.18). These questions require respondents to describe direct experience with Section 508-compliant websites and web portals, case management systems including the Medicare Appeals System, statistical extrapolation of claims, physician access for medical review, workforce development and management, quality assurance activities, prior Medicare contracting experience as a MAC, RAC, UPIC, or SMRC, ALJ hearing participation, and coordination with federal agencies and Medicare contractors. All responses must demonstrate direct relevance and capability to perform the specific QIC Lines of Business identified by the respondent.

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Other files

File	Type	Posted
Part C and D Jurisdiction Maps.pptx	PPTX presentation	Oct 15, 2026
Attachment 10 - QIC COI clause.pdf	PDF	Oct 15, 2026
OM Part B South SOW.pdf	PDF	Oct 15, 2026
OM DME QIC SOW_RFI.pdf	PDF	Oct 15, 2026
OM AdQIC SOW.pdf	PDF	Oct 15, 2026
OM_AdQIC_ Eligibility Contractor Activities - SOW.pdf	PDF	Oct 15, 2026
OM Part B North SOW.pdf	PDF	Oct 15, 2026
Original Medicare (OM) QIC Region Maps.pptx	PPTX presentation	Oct 15, 2026
OM Part A East SOW .pdf	PDF	Oct 15, 2026
Part C QIC - Statement of Work.pdf	PDF	Oct 15, 2026
Part D QIC - Statement of Work.pdf	PDF	Oct 15, 2026
QIC_RFI_2026.pdf	PDF	Oct 15, 2026
QIC IDIQ_ Umbrella SOW.pdf	PDF	Oct 15, 2026
OM Part A West SOW.pdf	PDF	Oct 15, 2026

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Sheet1

4.1 Programmatic and Operational Questions
	4.1.1) Based on the information provided in this RFI, describe your organization’s overall capability to perform some or all the work under the QIC IDIQ. Please explain.
	4.1.1a) Identify the specific QIC Line(s) of Business your organization is capable of supporting and provide a summary of the relevant and direct experience supporting each identified Line of Business.
	4.1.2) What barriers other than those related to Conflict of Interest, if any, does your organization believe may affect participation in the QIC IDIQ? Please explain.
	4.1.3) Has your organization previously considered participating in the QIC IDIQ? If yes, did your organization express that interest to CMS? If your organization considered participating but did not pursue the opportunity, please explain why and describe any factors that influenced that decision.
	4.1.4) In your opinion, what capabilities, operational requirements, or other factors present the greatest challenge to developing and maintaining a successful QIC operation? Additionally, what barriers, if any, may deter organizations from participating in the QIC IDIQ? Please explain.
	4.1.4a) CMS is seeking industry feedback regarding potential approaches to support the growing needs of the Medicare Part C Line of Business. One option under consideration would divide the current national Part C Line of Business into two task orders that perform the same business functions but serve different geographic areas. Please describe how this option would affect your organization's interest or ability to participate in the QIC IDIQ and explain the reasoning behind your response.
	4.1.5) Please describe your organization's experience, if any, related to Medicare Part A, B, and/or DME claims.
	4.1.6) Please describe your organization's experience, if any, reviewing Medicare claims for compliance with Medicare Part A, B, and/or DME coverage and policy requirements.
	4.1.7) Please describe your organization’s experience, if any, related to Medicare Part C organization determinations and appeals.
	4.1.8) Please describe your organization’s experience, if any, reviewing Medicare Part C organization determinations and appeals for compliance with Medicare coverage criteria and policy requirements.
	4.1.9) Please describe your organization's experience, if any, related to the Medicare Part D Prescription Drug Benefit.
	4.1.10) Please describe your organization's experience, if any, reviewing Medicare Part D prescription drug benefits for compliance with Medicare Part D coverage criteria and policy requirements.
	4.1.11) Please describe any additional thoughts, concerns, or recommendations your organization would like CMS to consider regarding participation in the QIC IDIQ. Please explain.
4.2 Conflict of Interest (COI) Focused Questions
	4.2.1) Based on your understanding of the COI requirements outlined in Attachments 10, 11, and 12, do you have any existing, potential, or perceived conflicts of interest that could affect your organization's ability to perform some or all the work under the QIC IDIQ? If yes, please describe the conflict(s) and explain whether and how they could be mitigated consistent with the existing QIC COI requirements outlined in Attachments 10, 11, and 12.
	4.2.1a) Based on the requirements of the QIC IDIQ and your organization's current work, are there arrangements under which your organization could perform some, but not all, of the QIC Lines of Business in a conflict-free manner? Please explain.
	4.2.2) Does your organization have any other Medicare program contracts or functions that are similar or related to functions performed by the QIC? Specifically, does your organization conduct medical review, coverage review, claims review, or other same/similar review activities related to Medicare? If so, in what capacity?
	4.2.3) How does your organization currently identify and address COI-related issues or concerns in its existing work? Please explain.
	4.2.4) What procedures does your organization have in place today to address COI requirements like those incorporated in the QIC IDIQ? Please explain. Also, is your organization able to submit a potential COI mitigation plan? If yes, please explain the proposed approach considering the existing COI policies for the QIC IDIQ as outlined in Attachments 10, 11, and 12. If not, please explain why your organization is unable to submit a potential COI mitigation plan.
	4.2.5) What procedures does your organization have in place to identify, monitor, and disclose personal conflicts of interest, including financial interests or relationships, involving managers or key personnel, governing body members, organizational principals, or other individuals whose interests could affect performance of the QIC contract? Please explain.
	4.2.6) Describe any additional thoughts or concerns your organization may have related to the QIC COI requirements. Please explain.
4.3 Relevant Experience and Capability
	Operational Infrastructure and Administrative Support
	4.3.1) Describe your organization's relevant and direct experience developing, operating, and maintaining Section 508-compliant public-facing websites, secure web portals, or similar web-based capabilities in support of Federal healthcare programs or other similar programs. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.2) Describe your organization's relevant and direct experience performing administrative processing of healthcare claims data, appeal case files, medical benefits-related case files and information, or other comparable case-related data, including document imaging, document management, scanning, uploading, downloading, and managing information within case management or other comparable systems. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.3) Describe your organization's relevant and direct experience providing administrative services necessary to support Medicare appeals operations or other similar appeals programs, including data analysis, reporting, and operational support activities. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.4) Describe your organization's relevant and direct experience performing case management and documentation activities, including electronic case management, document imaging, and the use of the Medicare Appeals System (MAS) or other comparable case management systems. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.5) Describe your organization's relevant and direct experience collecting, maintaining, and transmitting information regarding the receipt, workflow, and disposition of appeals or other similar activities using the Medicare Appeals System (MAS) or other comparable systems of record. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.6) Describe your organization's relevant and direct experience developing, obtaining, and managing medical records or other documentation necessary to support the analysis, review, and adjudication of appeals or other similar activities. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.7) Describe your organization's relevant and direct experience identifying, implementing, and sustaining process improvements within Medicare programs or other similar programs at the project, program, or enterprise level. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	Reconsideration and Appeals Operations
	4.3.8) Describe your organization's relevant and direct experience processing standard and expedited Medicare reconsiderations or other comparable health insurance appeals involving medical necessity, coverage, payment, or other adjudicative determinations. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.9) Describe your organization's relevant and direct experience applying Medicare statutes, regulations, coverage and payment policies, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), CMS manuals, or other governing authorities to support claims review, medical review, reconsiderations, appeals, or other similar adjudicative activities. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.10) Describe your organization's relevant and direct experience monitoring compliance with the timely effectuation of appeal decisions, including decisions that reverse, in whole or in part, an initial coverage or payment determination, or performing other similar activities. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.11) Describe your organization's relevant and direct experience conducting statistical extrapolation of Medicare appeals claims, reviewing appeals of Medicare claims previously subject to statistical extrapolation, or performing other similar statistical sampling and analysis activities. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	Clinical, Technical, and Professional Capability
	4.3.12) Describe your organization's relevant and direct experience providing access to physicians with experience and knowledge of Medicare coverage and payment policies necessary to support medical review activities related to Original Medicare, Medicare Part C, or Medicare Part D. Identify the applicable Medicare program(s), describe the physician expertise available to your organization, the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.13) Describe your organization's relevant and direct experience establishing, managing, and sustaining the professional workforce necessary to perform claims review, medical review, reconsiderations, appeals, or other similar adjudicative activities. Describe the key professional disciplines and functional roles supported, the work performed, your organization's role and responsibilities, and the approaches used to recruit, develop, train, manage, and retain this workforce. Explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.14) Describe your organization's relevant and direct experience performing or supporting claims auditing, quality assurance, or quality review activities as a prime contractor or subcontractor in support of Medicare or other similar healthcare programs, including evaluating the accuracy, consistency, and quality of claims, appeals, medical review activities, or other adjudicative determinations. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.15) Describe your organization's relevant and direct experience performing Medicare auditing or medical review activities, including experience acting as or supporting a Medicare Administrative Contractor (MAC), Recovery Audit Contractor (RAC), Unified Program Integrity Contractor (UPIC), Supplemental Medical Review Contractor (SMRC), or other similar Medicare program integrity or claims review function. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	Appeals Coordination and Program Integrity
	4.3.16) Describe your organization's relevant and direct experience participating in Administrative Law Judge (ALJ) hearings or other similar administrative appeal proceedings as a party, participant, witness, or in another authorized capacity. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a. If applicable, describe your experience under 42 CFR §§ 405.1010-405.1012 or comparable authorities.
	4.3.17) Describe your organization's relevant and direct experience coordinating with CMS, Medicare contractors, health plans, and other organizations to support Medicare appeals activities, including but not limited to, the Administrative QIC (AdQIC), other QICs, Medicare Administrative Contractors (MACs), Quality Improvement Organizations (QIOs), Medicare Secondary Payer (MSP) contractors, Medicare Advantage Organizations (MAOs), Part D plan sponsors, the Office of Medicare Hearings and Appeals (OMHA), the Medicare Appeals Council within the Departmental Appeals Board (Appeals Council), the Department of Justice (DOJ), the Office of Inspector General (OIG), the Government Accountability Office (GAO), or other similar organizations. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.
	4.3.18) Describe your organization's relevant and direct experience identifying and referring quality-of-care concerns or suspected fraud, waste, or abuse concerns in accordance with established procedures. Describe the work performed, your organization's role and responsibilities, and explain how the experience demonstrates your organization's capability to successfully perform the QIC Line(s) of Business identified in Section 4.1.1a.

File details come from the government source that posted it. Updated Oct 19, 2026.