Filing Medicare Managed Care Appeals
Appeals for denials of items/services must be sent to Maximus directly from the Medicare Health Plan. Maximus does not accept appeals sent to us directly from Medicare Health Plan Enrollees, Providers, or Representatives. The only exception to this is if a party wishes to appeal a Medicare Health Plan’s Notice of Dismissal of Appeal Request.
How to File An Appeal
How to File an Appeal of a Medicare Health Plan's Notice of Dismissal of Appeal Request:
These requests must be filed with Maximus and must be submitted in writing in one of the following ways:
- Via secure fax to 585-425-5292
- Via mail to the following address:
Maximus, Inc.
Medicare Managed Care & PACE Reconsideration Project
3750 Monroe Avenue, Suite 702
Pittsford, NY 14534-1302
In addition, if a party wishes to request an appeal of a Medicare Health Plan’s Notice of Dismissal of Appeal request, the request must include the following:
- A copy of the Notice of Dismissal of Appeal Request
- Any supporting documentation or information regarding your request
- Any representative documentation (i.e., Appointment of Representation forms, Powers of Attorney, etc.) that may be applicable
Medicare Health Plans options for sending appeal cases to Maximus include the following:
- QIC Appeal Portal at https://qicappeals.cms.gov
- Via mail to the following address:
Maximus, Inc.
Medicare Managed Care & PACE Reconsideration Project
3750 Monroe Avenue, Suite 702
Pittsford, NY 14534-1302 - Did you know that you can use the QIC Portal to submit your compliance information? Maximus’ QIC Portal is available 24/7 and is easy to use! You can find the user guide at this link.