Second Level of Appeal: Reconsideration by a Qualified Independent Contractor

A party to the redetermination may request a reconsideration if dissatisfied with the redetermination decision. A Qualified Independent Contractor (QIC) will conduct the reconsideration.

 
Filing a Request for Reconsideration

A written reconsideration request must be filed with a QIC within 180 days of receipt of the redetermination. To request a reconsideration, follow the instructions on your Medicare Redetermination Notice (MRN). A request for a reconsideration may be made on the standard form CMS-20033. (To link to this form, scroll down to "Downloads". This form is mailed with the MRN. If the form is not used, the written request must contain all of the following information:

• Beneficiary's name

• Beneficiary's Medicare health insurance claim (HIC) number

• Specific service(s) and item(s) for which the reconsideration is requested, and the specific date(s) of service

• Name and signature of the party or representative of the party

• Name of the contractor that made the redetermination

The request should clearly explain why you disagree with the redetermination. A copy of the MRN and any other useful documentation should be sent with the reconsideration request to the appropriate QIC. Documentation that is submitted after the reconsideration request has been filed, may result in an extension of the timeframe a QIC has to complete its decision. Further, the reconsideration request must contain any evidence noted in the redetermination as missing and any other evidence relevant to the appeal. However, it is not necessary to resubmit information that was already submitted to the contractor that made the redetermination. Evidence not submitted at the reconsideration level may be excluded from consideration at subsequent levels of appeal unless you show good cause for not submitting the evidence.

Reconsideration Decision Notification

Generally, the QIC will send its decision to all parties within 60 days of receipt of the request for reconsideration. The decision will contain detailed information on further appeals rights if the decision is not fully favorable. If the QIC cannot complete its decision in the applicable timeframe, it will inform the appellant of their right to escalate the case to an Administrative Law Judge.

Original Medicare (Fee-For-Service) Qualified Independent Contractors

The following is a list of the QICs and the jurisdictions that they serve:

Part A East Jurisdiction:     Maximus, Inc.  
Part A West Jurisdiction:   Maximus, Inc.
Part B North Jurisdiction:   C2C Solutions, Inc.
Part B South Jurisdiction:   Q2 Administrators, LLC
DME Jurisdiction:               C2C Solutions, Inc.

To view maps of the QIC jurisdictions, see "QIC Maps" below under "Downloads".