Section 1869 of the Social Security Act entitles any individual dissatisfied with the contractor's redetermination to file a request for a reconsideration within 180 days of receipt of the redetermination. There is no minimum amount in controversy to be met.
Please note: you may not request a reconsideration by the QIC unless you have first requested a redetermination by Palmetto GBA.
In accordance with §1869(c) of the Act, reconsideration are to be processed within 60 days by entities called Qualified Independent Contractors (QICs).
When a claim is denied on the basis of §1862(a)(1)(A) of the Act, the QIC reconsideration will consist of a panel of physicians and other health professionals. When the panel reviews services or items rendered by a physician or ordered by a physician, the panel will consist of at least one physician.
A reconsideration request form is included with each redetermination notice. A completed request and a copy of the redetermination notice should be mailed to the QIC address specified in the notice. A copy of the request form is available on our Web site.
- Jurisdiction 1: Forms
- Ohio: Forms
- South Carolina: Forms
- West Virginia: Forms
- All services: reconsiderations must be submitted on these forms. Submitting reconsideration requests without these forms or on the wrong forms may result in delays in handling your requests.
If made in writing, the request must include:
- The beneficiary's name
- Medicare health insurance claim number
- The specific services(s) and item(s) for which the reconsideration is requested and the specific date(s) of services
- The name and signature of the party or representative of the party
- The name of the contractor that made the redetermination
Note: We recommend that you include a copy of the redetermination notice with your QIC request.