Requests can be submitted in writing, by fax, or via the QIC Appeals Portal. To register for the QIC Appeals Portal and file your reconsideration request electronically please visit: http://www.medicaredmeappeals.com and select the option for "QIC Appeals Portal" under the "Medicare Appellants".
- Fill out a "Medicare Reconsideration Request Form." [ PDF, 180 KB]
- Submit a written request to the QIC that includes: Your name and Medicare Number. The specific item(s) or service(s) for which you're requesting a reconsideration and the specific date(s) of service.
What is the QIC portal for Medicare Appeals?
Welcome to the QIC Appeals Portal for Independent Review of Medicare appeals, operated on behalf of The Centers for Medicare and Medicaid Services. Who May Register? The QIC Portal is intended for use by healthcare providers, suppliers, office staff, billing companies, and Medicare health plans.
How do I request a Medicare redetermination from the QIC?
Send a copy of the "Medicare Redetermination Notice," and any other information that may help your case, with your reconsideration request to the QIC. You must send your request to the QIC that will handle your reconsideration. The QIC's address is listed on the redetermination notice.
How do I file a reconsideration request with the QIC?
The QIC will review your request for a reconsideration and make a decision. The redetermination notice you got in level 1 has directions for you to file a request for reconsideration. There are 2 ways to submit a reconsideration request. Fill out a " Medicare Reconsideration Request Form." [PDF, 180 KB]
Where can I find the name and mailing address for the QIC?
The name and mailing address for the QIC can be found in your redetermination letter along with a reconsideration request form (the form sent with your letter is slightly different than the CMS-2003 form.) Note: Mail the reconsideration request form to the QIC only. Do not send to Novitas Solutions.
Which level of a Medicare appeal is determined by a QIC?
Level 2Level 2: Reconsideration by Qualified Independent Contractor (QIC)
What is the difference between reconsideration and redetermination?
Any party to the redetermination that is dissatisfied with the decision may request a reconsideration. A reconsideration is an independent review of the administrative record, including the initial determination and redetermination, by a Qualified Independent Contractor (QIC).
How do I write a Medicare reconsideration letter?
Include this information in your written request:Your name, address, and the Medicare Number on your Medicare card [JPG]The items or services for which you're requesting a reconsideration, the dates of service, and the reason(s) why you're appealing.More items...
What is Medicare QIC?
A Qualified Independent Contractor (QIC) is an independent entity with which Medicare contracts to handle the reconsideration level of an Original Medicare (Part A or Part B) appeal.
How do I submit a reconsideration request to Medicare?
There are 2 ways to submit a reconsideration request.Fill out a "Medicare Reconsideration Request Form." [ PDF, 180 KB]Submit a written request to the QIC that includes: Your name and Medicare Number. The specific item(s) or service(s) for which you're requesting a reconsideration and the specific date(s) of service.
How long does Medicare have to process a redetermination?
within 60 daysYou'll generally get a decision from the MAC (either in a letter or an MSN) called a "Medicare Redetermination Notice" within 60 days after they get your request. If you disagree with this decision, you have 180 days after you get the notice to request a reconsideration by a Qualified Independent Contractor (QIC).
What percentage of Medicare appeals are successful?
For the contracts we reviewed for 2014-16, beneficiaries and providers filed about 607,000 appeals for which denials were fully overturned and 42,000 appeals for which denials were partially overturned at the first level of appeal. This represents a 75 percent success rate (see exhibit 2).
What is a reconsideration in Medicare?
If you disagree with the initial decision from your plan (also known as the organization determination), you or your representative can ask for a reconsideration (a second look or review). You must ask for a reconsideration within 60 days of the date of the organization determination.
How long does it take to get a reconsideration decision?
A reconsideration appeal can usually be decided in as little as four weeks or as long as twelve weeks; whereas an application for disability can take as long as six months (usually, if it takes this long it is due to difficulties in procuring medical records from various doctors and other medical providers).
What is a reconsideration form?
If you do not wish to appeal a "non-medical" decision online, you can use the Form SSA-561, Request for Reconsideration. Some examples of "non-medical" decisions are: you were denied another type of benefit, such as retirement or spouse's; your disability application was denied because you did not work long enough; or.
What is the difference between reconsideration and appeal?
If you're asking for a reconsideration, you're not appealing. It's sort of a new claim, a reopened claim, whatever you want to call it. You've got to say, “I disagree” and now there's a form that you have to use.
What is a QIO appeal?
If you think your Medicare services are ending too soon (e.g. if you think you are being discharged from the hospital too soon), you can file an appeal with your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).
How long does it take for Medicare to redetermine?
The redetermination decision is presumed to be received 5 days after the date on the notice unless there is evidence to the contrary. A reconsideration must be requested in writing.
How long does a request for review take?
The request for review must be filed with the QIC within 60 days after the date of receipt of the dismissal. When the QIC performs its review of the dismissal, it will only decide on whether or not the dismissal was correct.
How long does it take to get a reconsideration decision?
Generally, the QIC will send this decision to all parties within 60 days of receipt of the request for reconsideration. If the QIC is unable to complete its reconsideration within this timeframe (with exceptions for extensions for additional evidence submissions and late filing), the QIC must send a notice to the parties and advise the appellant of the right to escalate the appeal to OMHA. If the party chooses to escalate the appeal to OMHA, a written request must be filed with the QIC in accordance with instructions on the escalation notice.
Can you request a reconsideration after a QIC has been filed?
A minimum monetary threshold is not required to request a reconsideration. Documentation that is submitted after the reconsideration request has been filed may result in an extension of the timeframe a QIC has to complete its decision. This does not apply to timely submission of documentation requested by the QIC.
Can a QIC dismiss a reconsideration request?
A QIC may dismiss a reconsideration request in the following instances: If the party (or appointed representative) requests to withdraw the appeal; or. If there are certain defects, such as. The party fails to file the request within the appropriate timeframe and did not show (or the QIC did not accept) good cause for late filing. ...
When will the QIC end in 2021?
July 20, 2021 - Reminder of Demonstration End Date. As a reminder, all activities related to Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration will be ending December 31, 2021. This includes activities conducted by both the Durable Medical Equipment (DME) and Part A East QIC contractors.
When is the Medicare Learning Network call?
February 18, 2020 - Medicare Learning Network Provider Call Announcement. On March 5, 2020, CMS will host a Medicare Learning Network Provider Call to offer Part A providers information on the QIC Appeals Demonstration process, how to identify if they are eligible, and how to participate.
How to contact Medicare about ALJ hearing?
You can find more information about the ALJ hearing process at the Office of Medicare Hearings and Appeals website, or call us at 1-800-MEDICARE (1-800-633-4227).
What happens if you ask OMHA for a decision without a hearing?
If you have asked OMHA for a decision without a hearing, but the ALJ decides a hearing is necessary, the ALJ will let you know when the hearing will be. If no hearing is held, either an ALJ or attorney adjudicator will review the information in your appeal record and issue a decision.
Can an OMHA make a decision without a hearing?
You can ask OMHA to make a decision without holding a hearing (based only on the information that's in your appeal record). The ALJ or attorney adjudicator may also issue a decision without holding a hearing if evidence in the hearing record supports a decision that's fully in your favor.
What is a QIC portal?
The Qualified Independent Contractor (QIC) portal is a web application that enables users to electronically submit reconsideration appeal requests and case files to Maximus Federal, therefore eliminating the need to fax or mail them.
What is a requestor in a court case?
requestor is a person legally authorized to request an appeal on behalf of another person or entity. The requestor is formally named in representation documentation and proof of representation is required. A requestor may also submit appeals.
Can an additional user add a plan to QIC?
An additional user can add any plans that exist in the system, even plans that are not administered by his/her own QIC Portal Administrator.
Can you be the administrator of a QIC plan?
You have the option of adding the plan to your account. You cannot be the administrator for this plan.
What is the Medicare block 1?
Block 1 - Beneficiary name: Include the first and last name of the beneficiary as it appears on the Medicare card. Block 2 - Medicare number: Include the beneficiary's complete Medicare number as found on their Medicare card. Block 3 - Item or service you wish to appeal: Provide a complete description of the item or service in question.
How long does it take to get a reconsideration notice?
A request for reconsideration must be filed within 180 days after the date of receipt of the redetermina tion notice.
What is the phone number for Medicare Appeals Council?
Medicare agency rulings may also apply. If you have questions about the Council, you may call (202) 565-0100. Medicare Appeals Council Action. The Council will limit its review to the issues raised in the appeal, unless the appeal is filed by an unrepresented beneficiary.
What is included in an appeal for Medicare?
Your written appeal must include: the beneficiary's name; the beneficiary’s Medicare number; the item or service in dispute; the date of the item or service; the date of the ALJ’s decision; and. your name, and, if applicable, the name of your representative.
Calculate Submission Timeline
Reconsiderations requested on or after September 1, 2019 will be submitted to Maximus Federal.
Appeal Rights on Dismissals
To vacate a dismissal, file a request to Noridian within six months of dismissal letter receipt date. The request must include an explaination detailing why you believe to have good and sufficient cause for failing to include proper information in original redetermination request
Mail Requests to
To file your reconsideration request with MAXIMUS by mail or fax send to:
Requesting A Reconsideration
- The appellant (the individual filing the appeal) has 180 days from the date of receipt of the redetermination decision to file a reconsideration request. The redetermination decision can be communicated through a Medicare Redetermination Notice (MRN), a Medicare Summary Notice (MSN), or a Remittance Advice (RA). The redetermination decision is pres...
QIC Review of A Dismissal of A Redetermination Request
- If a MAC has dismissed a redetermination request, any party to the redetermination has the right to appeal a dismissal of a redetermination request to a QIC if they believe the dismissal is incorrect. The request for review must be filed with the QIC within 60 days after the date of receipt of the dismissal. When the QIC performs its review of the dismissal, it will only decide on whethe…
Dismissal of A Reconsideration Request
- A QIC may dismiss a reconsideration request in the following instances: 1. If the party (or appointed representative) requests to withdraw the appeal; or 2. If there are certain defects, such as 2.1. The party fails to file the request within the appropriate timeframe and did not show (or the QIC did not accept) good cause for late filing 2.2. The representative is not appointed properly 2.…