Qlarant Notice of Suspension Rebuttal

What the letter looks like

Letterhead from Qlarant Integrity Solutions, LLC, Easton, MD. Signed by the Manager, Program Integrity. Subject line: "Notice of Suspension of Medicare Payments." Citing 42 C.F.R. § 405.371(a)(2) and 405.372(a)(4)(iii). Allegations typically include patterns CMS has flagged through claims data mining — live discharge rates, length-of-stay outliers, terminal illness recertification gaps, or face-to-face encounter documentation issues.

The letter will list specific claim control numbers (CCNs) and dates of service that triggered the review. It tells you to direct rebuttals to:

UPICW Rebuttal and Suspension Department
28464 Marlboro Avenue, Easton, MD 21601-2732
adminactions_upicw@qlarant.com

What CMS expects in the rebuttal

"Merely providing general assertions or denials will typically be insufficient to overcome the allegation(s)." That's their language, not ours. The rebuttal needs claim-specific evidence, including:

• Signed Election Statement by the beneficiary or authorized representative
• Election Statement Addendum if requested by the beneficiary or other applicable party
• Documentation of the required face-to-face encounter with a qualified medical professional
• Initial 90-day Certification of Terminal Illness with physician narrative
• Recertification of Terminal Illness for all subsequent benefit periods
• Plan of Care required for all subsequent benefit periods
• Interdisciplinary Team (IDT) meeting documentation

How we help

We don't write the medical necessity language — that stays with your Medical Director. What we do:

• Read the specific allegations in your letter and identify the documentation gaps that map to them
• Triage the listed CCNs into "strong rebuttal" / "weak rebuttal" / "concede" buckets
• Review your election, addendum, F2F, certification, and IDT documentation for technical accuracy — signatures, dates, credentials, required language
• Draft the cover letter framing for the UPICW team, structured the way they read
• Live-discharge-rate benchmarking against the national 18.22% figure CMS uses

What it costs

Two doors:

Want to learn before you book? The free CMS Suspension Q&A webinar at Hospice Engine runs daily at 10am Pacific.