State

Fiscal Intermediary Appeals Address

Qualified Independent Contractor Address

California

National Government Services, Inc.
Appeals Department
P.O. Box 7149
Indianapolis, Indiana 46207-7138

First Coast Service Options
QIC Part A West
532 Riverside Avenue 6T
Jacksonville, Florida 32202

Connecticut

National Government Services, Inc.
Medicare Appeals Department
P.O. Box 4711
Syracuse, New York 13221-4711

Maximus Federal Services, Inc., QIC
Part A East Project
1040 First Avenue, Suite 400
King of Prussia, Pennsylvania 19406

Delaware

National Government Services, Inc.
Medicare Appeals Department
P.O. Box 4711
Syracuse, New York 13221-4711

Maximus Federal Services, Inc., QIC
Part A East Project
1040 First Avenue, Suite 400
King of Prussia, Pennsylvania 19406

Illinois

National Government Services, Inc.
Appeals
P.O. Box 7138
Indianapolis, Indiana 46207-7138

First Coast Service Options Part A Reconsiderations
P.O. Box 45029
Jacksonville, Florida 32232-5029

Indiana

National Government Services, Inc.
Appeals
P.O. Box 7138
Indianapolis, Indiana 46207-7138

First Coast Service Options Part A Reconsiderations
P.O. Box 45029
Jacksonville, Florida 32232-5029

Kentucky

National Government Services, Inc.
Appeals
P.O. Box 7138
Indianapolis, Indiana 46207-7138

First Coast Service Options Part A Reconsiderations
P.O. Box 45029
Jacksonville, Florida 32232-5029

Maine

National Government Services, Inc.
Medicare Appeals Department
P.O. Box 4711
Syracuse, New York 13221-4711

Maximus Federal Services, Inc., QIC
Part A East Project
1040 First Avenue, Suite 400
King of Prussia, Pennsylvania 19406

Massachusetts

National Government Services, Inc.
Medicare Appeals Department
P.O. Box 4711
Syracuse, New York 13221-4711

Maximus Federal Services, Inc., QIC
Part A East Project
1040 First Avenue, Suite 400
King of Prussia, Pennsylvania 19406

Michigan

National Government Services, Inc.
Appeals Department
P.O. Box 7149
Indianapolis, Indiana 46207-7138

First Coast Service Options
QIC Part A West
532 Riverside Avenue 6T
Jacksonville, Florida 32202

New Hampshire

National Government Services, Inc.
Medicare Appeals Department
P.O. Box 4711
Syracuse, New York 13221-4711

Maximus Federal Services, Inc., QIC
Part A East Project
1040 First Avenue, Suite 400
King of Prussia, Pennsylvania 19406

New York

National Government Services, Inc.
Medicare Appeals Department
P.O. Box 4711
Syracuse, New York 13221-4711

Maximus Federal Services, Inc., QIC
Part A East Project
1040 First Avenue, Suite 400
King of Prussia, Pennsylvania 19406

Ohio

National Government Services, Inc.
Appeals
P.O. Box 7141
Indianapolis, Indiana 46207-7138

First Coast Service Options Part A Reconsiderations
P.O. Box 45029
Jacksonville, Florida 32232-5029

Vermont

National Government Services, Inc.
Medicare Appeals Department
P.O. Box 4711
Syracuse, New York 13221-4711

Maximus Federal Services, Inc., QIC
Part A East Project
1040 First Avenue, Suite 400
King of Prussia, Pennsylvania 19406

Virginia

National Government Services, Inc.
Appeals Department
P.O. Box 7149
Indianapolis, Indiana 46207-7138

Maximus Federal Services, Inc., QIC
Part A East Project
1040 First Avenue, Suite 400
King of Prussia, Pennsylvania 19406

West Virginia

National Government Services, Inc.
Appeals Department
P.O. Box 7149
Indianapolis, Indiana 46207-7138

Maximus Federal Services, Inc., QIC
Part A East Project
1040 First Avenue, Suite 400
King of Prussia, Pennsylvania 19406

Wisconsin

National Government Services, Inc.
Appeals Department
P.O. Box 7149
Indianapolis, Indiana 46207-7138

First Coast Service Options
QIC Part A West
532 Riverside Avenue 6T
Jacksonville, Florida 32202

American Samoa Islands, Guam, Hawaii, Northern Marianna Islands

National Government Services, Inc.
Appeals Department
P.O. Box 7149
Indianapolis, Indiana 46207-7138

First Coast Service Options
QIC Part A West
532 Riverside Avenue 6T
Jacksonville, Florida 32202