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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.