Reconsideration by Part C Independent Review Entity (IRE)

If a Medicare Advantage (Part C) health plan makes an adverse reconsideration decision (upholds its initial adverse organization determination), in whole or in part, the plan must automatically submit the case file and its decision for review by the Part C Independent Review Entity (IRE). If the plan dismisses a plan reconsideration request, the enrollee, the enrollee’s representative or non-contract provider  has the right to file a request for review of the plan dismissal with the IRE.

CMS is in the process of transitioning the Part C IRE contractor.  MAXIMUS Federal Services is the former Part C IRE and will continue processing reconsideration requests received through April 30, 2026. Effective May 1, 2026, C2C Innovative Solutions, Inc. (C2C) is the Part C IRE. 

For additional information about the reconsideration process, click on the MAXIMUS Federal or C2C link in the “Related Links” section below. 

For more information about appeals and dismissal review requests with the Part C IRE, see Section 60 of the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance, in the “Downloads” section below.

How to Request an IRE Review of a Plan Dismissal 

An enrollee, an enrollee's representative, or a non-contract provider  may request a reconsideration of a plan dismissal.

• The request must be filed with the IRE within 65 calendar days from the date of the plan dismissal decision notice.
• The request must be made in writing, which includes by fax.
• Until 04/30/2026, the request must be sent to the IRE, MAXIMUS, at:

                        Maximus
                        Medicare Managed Care & PACE Reconsideration Project
                        3750 Monroe Avenue
                        Suite 702
                        Pittsford, NY 14534-1302 
                        Fax: 585-425-5292

• Starting 05/01/2026, the request must be sent to the IRE, C2C, at:

             United States Postal Service (USPS): 
             C2C Innovative Solutions, Inc. - QIC Part C
             Attn: QIC Part C - New Plan Dismissal Appeal 
             P.O. Box 1949 
             Jacksonville, FL 32231-0053

             UPS / FedEx Only: 
             C2C Innovative Solutions, Inc. - QIC Part C 
             Attn: QIC Part C - New Plan Dismissal Appeal
             301 W. Bay St., Suite 1110 
             Jacksonville, FL 32202

             Fax: (904) 539-4080 
             Phone: 1-866-320-0963                                      

How the IRE Processes Reconsideration Requests

Once the case file or appeal is received by the IRE, the IRE must make its decision and provide written notice of its decision as quickly as the enrollee's health requires, but no later than the following timeframes:

• Expedited requests: 72 hours 
• Standard Pre-service requests:  30 calendar days 
• Standard Part B drug requests: 7 calendar days
• Payments requests: 60 calendar days

An extension of up to 14 calendar days is available if:  

1. requested by the enrollee; or 
2. actions are required by the QIC to address deficiencies in the reconsideration case file, with appropriate notification to the enrollee in accordance with regulations.  

The QIC shall document the case file with the justification and rationale for the extension 

Extensions are not permitted for Part B drug requests.

If the IRE decision is unfavorable or partially favorable, the decision notice will contain the information needed to file a request for a hearing with an Administrative Law Judge within the Office of Medicare Hearings and Appeals (OMHA). Parties to the hearing may waive their right to the oral hearing and request that a decision be made based on the record. Use the left navigation menu on this page to link to other pages that contain detailed information about hearings with an ALJ and obtaining an on the record review by OMHA, or any other level of appeal.

Fact Sheets: Part C Reconsideration Appeals Data

These reports summarize and highlight key Part C IRE reconsideration data from January 1, 2017 to the most recently available date.  

To view the Fact Sheets, click on the link in the "Downloads" section below.