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Filing a Part A West Appeal

The Part A West Qualified Independent Contractor (QIC) jurisdiction encompasses the following states:

Washington, Idaho, Montana, North Dakota, South Dakota, Iowa, Missouri, Kansas, Nebraska, Wyoming, Utah, Arizona, Nevada, California, Alaska, Hawaii, Oregon, Kentucky, Ohio, Indiana, Illinois, Minnesota, Michigan, Wisconsin, Guam, Northern Mariana Islands, American Samoa

How to File An Appeal

When to File a Part A West Standard Appeal

After a Part A or Home Health and Hospice Medicare Administrative Contractor (MAC) has made a redetermination (first level appeal) decision for fee-for-service Medicare items or services, you may file a reconsideration (second level appeal) request with Maximus Federal Services as follows:

  • The request must be filed with Maximus Federal Services and can be submitted via the following methods:
    • QIC Appeals Portal at https://qicappeals.cms.gov
    • In writing, mailed to:

      QIC Part A West
      Maximus Federal Services, Inc.
      Medicare Part A West
      3750 Monroe Avenue
      Suite 706
      Pittsford, NY 14534-1302
    • Via secure fax at 1-585-869-3346
  • The request must be in writing and should be made on a standard CMS form. A written request that is not made on a standard CMS form is accepted if it contains the same required elements as follows:
    • The beneficiary’s name
    • Medicare Beneficiary Identifier or 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 of the party or the representative of the party
    • The name of the contractor that made the redetermination
  • QIC Appeals Portal

    QIC Appeals Portal User Guide

For the status of your appeal, please use the appeal status lookup tool: Q2 Administrators > Home

When to File a Part A West Expedited Appeal

After a Beneficiary and Family Centered Quality Improvement Organization (BFCC-QIO) has made a redetermination (first level appeal) decision on notice of discharge or service termination by a Medicare covered skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice agency, you may file an expedited reconsideration (second level appeal) request as follows:

  • A beneficiary who wishes to obtain an expedited reconsideration must submit a request for reconsideration to Maximus Federal Services, in writing via fax or verbally by telephone, by no later than noon of the calendar day following initial notification (by telephone or in writing) of the BFCC-QIO's determination
  • The request must be filed with Maximus Federal Services and can be submitted via the following methods:
    • By phone toll free at 1-866-950-6509
    • Via secure fax at 1-585-869-3365

Request a Duplicate Copy of a Decision Letter

If you’d like to request a copy of a decision letter, please click here to submit a request. For additional information on this process click here

Key Contacts

If you have any question or concerns about the Part A West QIC, please contact the Project Director, Tammy Tucci  (TammyLTucci@maximus.com)

Providers with questions may call and leave a message for a callback at: 1-585-348-3020

Beneficiaries may direct their questions to the Medicare Service Center at 1-800-MEDICARE or 1-800-633-4227

For information about the availability of auxiliary aids and services, please visit: 
http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html 

Submitting Personal or Confidential Information

Any document that contains the identity of a beneficiary or a provider is confidential.  For this reason, Maximus Federal Services cannot accept confidential information sent via email transmission.  Submit confidential information to Maximus Federal Services in hard copy by US mail, commercial delivery service or via secure fax to 585-869-3346

Sending an Email

Electronic mail is not necessarily secure against interception. If your communication is very sensitive or includes personal information, please send it by postal mail or fax (585-869-3346) instead.  If you still wish to email us, please send to PartAInfo@Maximus.com