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Reconsideration

Medicare Claims Processing Manual (Pub 100-04 Ch. 29 §320) Globe to indicate www links

A reconsideration is the second level of appeal.  Reconsiderations are processed by Qualified Independent Contractors (QICs) that consist of a panel of physicians, and other health professionals. 

Who May Appeal

Any individual dissatisfied with the redetermination notice may file a request for reconsideration. 

How to Request A Reconsideration

Reconsiderations must be submitted within 180 days of the date on the notice of redetermination letter.

The request for reconsideration must be made in writing either on the CMS-20033 Medicare Reconsideration Request Form Globe to indicate www links or a written request that includes the following items.

  • The beneficiary’s name;
  • Medicare health insurance claim number;
  • The specific service(s) and item(s) for which the reconsideration is requested and the specific date(s) of service;
  • The name and signature of the person requesting the appeal; and
  • The name of the Medicare contractor that made the redetermination decision.

The notice of redetermination letter will include the name and address of the QIC that has jurisdiction for your state.  Mail the reconsideration request to the QIC indicated.  The QIC has 60 days to process their decision.  The QIC will send a letter notifying you of their decision.

Page last updated: May 5, 2008

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