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.

  1. Complete and submit the standard CMS 20033 - Medicare Reconsideration Request form
  2. 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 Tue, 26 Jun 2018 09:50:40 +0000