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 as follows:

• The request must be filed with Maximus 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, 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/billing agency 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 Care 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, 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 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