Reconsideration - JA DME

A Reconsideration is the second level of an appeal. Submit a request if dissatisfied with a Redetermination.

Reconsiderations requested on or after September 1, 2019 will be submitted to Maximus Federal.

A reconsideration (second level appeal) request may be filed with MAXIMUS Federal as follows:

1. Requests can be submitted in writing, by fax, or via the QIC Appeals Portal.
   • To register for the QIC Appeals Portal and file your reconsideration request electronically please visit: Medicare Durable Medical Equipment (DME) Appeals and select the option for "QIC Appeals Portal" under the "Medicare Appellants".
2. Complete the CMS 20033 - Medicare Reconsideration Request Form for written requests.
3. Written requests must be filed with MAXIMUS Federal at the address or fax listed below. This MAXIMUS address will be indicated on the notice of redetermination.
4. The request must be in writing if not submitted on a Reconsideration form and must contain:
   • The beneficiary's name
   • Medicare Beneficiary ID
   • The specific service(s) and item(s) for which the reconsideration is requested and the specific date(s) of service
   • The name of the party or the representative of the party
   • The name of the contractor that made the redetermination

Appeal Rights on Dismissals

• Parties to Redetermination can appeal a dismissal to QIC
• Reconsideration request must be filed within 60 days of dismissal date
• Requestor may also ask Noridian to vacate dismissal
  • To vacate a dismissal, file a request to Noridian within six months of dismissal letter receipt date. The request must include an explanation detailing why you believe to have good and sufficient cause for failing to include proper information in original redetermination request

Mail Requests to:

To file your reconsideration request with MAXIMUS by mail or fax send to:

MAXIMUS Federal
DME - QIC Project
3750 Monroe Avenue, Suite 777
Pittsford, NY 14534
Fax: 585-869-3314 or 585-869-3315

Check the status of a request in the Q2Administrators Appeals Status tool.

Contact MAXIMUS Federal by phone at 585-348-3200, or by email at DMEInfo@MAXIMUS.com with any DME Reconsideration process related inquiries.