If you are dissatisfied with a Redetermination, you may go to the next level of appeal, called a Reconsideration.
|Time Limit for Filing Request||Monetary Threshold to be Met||Time Limit to Complete Appellant's Request||Where to File|
|180 days from Redetermination receipt date||None||60 days from receipt date||Qualified Independent Contractor (QIC)|
A Reconsideration may be requested and submitted to Maximus Federal Services in one of two ways.
- Complete and submit the standard CMS 20033 - Medicare Reconsideration Request form
- Submit a written request containing at least the following information
- Beneficiary's name
- Medicare health insurance claim number
- Specific service(s) and item(s) for which Reconsideration is requested and specific date(s) of service
- Name and signature of party or representative of party
- Name of 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 us to vacate the dismissal
- To vacate a dismissal, file a request within 6 months of dismissal letter receipt date. In request, explain why you believe to have good and sufficient cause for failing to include proper information in request
Send Reconsideration requests to:
Maximus Federal Services
3750 Monroe Ave.
Part A West-Suite 706
Pittsford, NY 14534
Last Updated Jan 12, 2018