Beneficiaries, providers, and suppliers have the right to appeal Medicare coverage and payment decisions.  Should a provider be dissatisfied with the results of a first-level appeal (redetermination), they may request a second-level decision.  All second-level appeals, known as reconsiderations, must be conducted by Qualified Independent Contractors (QICs).

Effective December 15, 2008, the Centers for Medicare & Medicaid Services (CMS) announced that MAXMUS Federal Services is the Qualified Independent Contractor (QIC) for Part A East and West Jurisdictions. The states under MAXIMUS’ jurisdiction include:

Please note that a request for reconsideration must be filed within 180 days of the redetermination decision.  To file this request, please follow instructions on the Medicare Redetermination Notice (MRN) for the completion of Form CMS-20033 or complete a written request including the beneficiary’s name, Medicare health insurance claim (HIC) number, dates of service, specific service(s) and item(s) for which reconsideration is requested, name and signature of the party or representative of the party, and the name of the contractor that made the redetermination.  This request should be filed with the contractor responsible for the state in which the services were rendered.  However, if you are a chain provider, ensure that your request is sent to the QIC who has jurisdiction in the state where the claim was processed.  This reconsideration request, and any other correspondence with MAXIMUS, should be addressed to:

MAXIMUS Federal Services
1040 First Avenue, Suite 310
King of Prussia, PA 19406
Provider Inquiries:  (484) 688-2000

If you have any questions, please contact our provider service center at our toll-free number, 1-877-567-9249 (for North Carolina and South Carolina Part A providers) or 1-866-801-5301 (for home health and hospice providers).