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QIOs are focused more on quality improvement projects in relation to medical review, medical necessity and quality of care issues. Unlike the PSCs, the QIOs are not charged with proactively identifying fraud. However, the QIO is permitted to make referrals to the PSC for benefit integrity issues. Likewise, the PSC may refer cases to the QIO for medical necessity and quality of care issues.
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How does the PSC differ from the QIO?
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