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business people in a meeting Joint Operating Agreement
We are the Medicare Quality Improvement Organization, working to improve the quality of care for Medicare beneficiaries. Our site offers beneficiary and family-centered care information for providers, patients, and families. Welcome!

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purpose of the agreement

The purpose of this agreement is to determine the operational procedures regarding the review of services for which payment may be made. This agreement will define the relationship between the parties to exchange information and data about the efforts of the Centers for Medicare & Medicaid Services (CMS) to promote quality healthcare services for people who are on Medicare and to determine if services provided to Medicare patients are medically necessary, appropriate, and meet professionally recognized standards of care.

The entities that are required to have a Joint Operating Agreement ( JOA) are the Medicare Administrative Contractor (MAC), the Unified Program Integrity Contractor (UPIC), the Zone Program Integrity Contractor (ZPIC), and the Qualified Independent Contractor (QIC).

statutory specifications

Quality Improvement Organizations are authorized to perform Medicare peer review as defined in Titles XI and XVIII of the Social Security Act (here in after referred to as the Act). This authorization is made effective through the QIO’s contract with CMS. Regulations at 42 CFR 476.80, requires a QIO to maintain a Joint Operating Agreement (JOA) with each Medicare Contractor processing cases it reviews. The JOA must reflect mutually agreeable conditions necessary for data exchange requirements in recognitions of the unique capabilities/requirements of each party.

If you have any questions about the JOA process, please send an email to joa@kepro.com.


  1. Click on the button below to fill out the JOA document.
  2. When you have finished, there will be a submission button at the end of the JOA.

    Complete Joint Operating Agreement

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