Submit a Reconsideration

The second level of appeal is the reconsideration and is carried out by the QIC.

• Time limit to initiate = 180 days from date of receipt of redetermination decision
• Time limit to complete the review = 60 days
• Amount in controversy = no minimum amount

Go to the Original Medicare (Fee-for-service) Appeals page on the CMS website for additional information regarding reconsiderations and QICs.

Submit Your Reconsideration

In Writing

Please complete the CMS-20033 Medicare Reconsideration Request Form or the reconsideration request form included with the redetermination decision.

Send the completed CMS-20033 Medicare Reconsideration Request Form to the QIC appeals mailing address:

Jurisdiction K 

C2C Innovative Solutions, Inc.
QIC Part A East Appeals
P.O.  Box 45305
Jacksonville, FL 32232-5305

C2C Website

Jurisdiction 6

MAXIMUS Federal Services, Inc.
QIC Medicare Part A West
3750 Monroe Ave. Suite 706 
Pittsford, NY 14534