QIC Case File Development

320.4 - QIC Case File Development (Rev. 4380, Issued: 08-30-19, Effective: 07-08-19, Implementation: 10- 01-19) When the QIC receives a request for reconsideration, it will request the case file from the MAC with jurisdiction using the Redetermination Case File Request Form. The QIC will send the request either by email, telephone, fax, or by any other method agreed upon in the JOAs. (Note: Individually identifiable beneficiary information should not be given in an unsecure email.) If another method is agreed upon in the JOAs, it must meet the privacy requirements of HIPAA. If agreed upon in the JOAs, the following requirements apply to email, fax and phone requests: (a) Email requests - MACs shall maintain an email account specifically for the receipt of case file requests from the QIC. If individually identifiable information is given in the request or response, a secure email account must be used. MACs must check this email account at least once daily (every business day). When MACs receive email requests from the QIC, they shall notify the QIC of receipt. (b) Phone Requests - MACs shall designate and maintain a phone extension specifically for the receipt of case file requests from the QIC. MACs shall designate a main contact person and back-up contact that is available to take phone calls during core business hours on all business days (unless otherwise agreed upon in the JOAs). (c) Fax Requests - MACs shall designate and maintain a fax machine for the receipt of case file requests from the QIC.