Reconsideration (Second Level Appeal) by a Qualified Independent Contractor (QIC)

A second level appeal is called a Reconsideration.  Requests for a Reconsideration must be filed with a Qualified Independent Contractor (QIC).  The name and address of the QIC will be specified in each Redetermination notice.  Requests should be submitted in writing with a copy of the Redetermination Notice to the following address:

Maximus QIC Part A East Project

1040 First Avenue, Suite 400
King of Prussia, PA 19406

A Reconsideration request form should be used and will be provided with each Redetermination notice issued.  A Reconsideration Request Form can be downloaded from the forms section of our website.  In lieu of the form, the Reconsideration request must include the following items:
The beneficiary’s name;

  • Medicare health insurance claim number
  • The specific service(s) and items (s) for which the reconsideration is requested and the specific date(s) of service;
  • The name and signature of the party or representative of the party; and
  • The name of the contractor that made the Redetermination  

A request for reconsideration must be filed within 180 days of the date of receipt of the notice of the Redetermination.  The date of filing for request filed in writing is defined as the date received by the QIC in their corporate mailroom