Review by Part C Independent Review Entity (IRE)
If, upon reconsideration, a Medicare Advantage (Part C) health plan upholds its initial adverse organization determination, the plan must submit the case file and its decision for automatic review by the Part C Independent Review Entity (IRE). For more information about the Part C IRE, see Sections 80.3 - 90 in Chapter 13 of the Medicare Managed Care Manual in the “Downloads” section below.
Currently, MAXIMUS Federal Services is the Part C IRE. For additional information about MAXIMUS' reconsideration process, click on the MAXIMUS Federal Services link in the “Related Links” section below.
Fact Sheets: Part C Reconsideration Appeals Data
These reports summarize and highlight key Part C IRE reconsideration data from January 1, 2010 to December 31, 2017.
To view the Fact Sheets, click on the link in the "Downloads" section below.
- Fact Sheets: Part C Reconsideration Appeals Data [ZIP, 1MB]
- Chapter 13 - Medicare Managed Care Beneficiary Grievances, Organization Determinations, and Appeals Applicable to Medicare Advantage Plans, Cost Plans, and Health Care Prepayment Plans (HCPPs), (collectively referred to as Medicare Health Plans) [PDF, 426KB]
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