Maximus Federal Services, Inc. Is the Qualified Independent Contractor (QIC) for the Part A West Jurisdiction
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 September 1, 2016, Maximus Federal Services, Inc. is the Qualified Independent Contractor (QIC) for Part A West Jurisdiction. The states under the Maximus Federal Services jurisdiction include:
Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Ohio, Oregon, South Dakota, Utah, Washington, Wisconsin and Wyoming.
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 (PDF, 42 KB) or complete a written request including the beneficiary’s name, Medicare ID 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 Federal Services should be addressed to:
Maximus Federal Services
3750 Monroe Ave
Part A West – Suite 706
Pittsford, NY 14534