Reconsideration by QIC-Second Level of Appeal

Section 1869(c) of the Social Security Act was amended by the Benefits Improvement and
Protection Act of 2000 (BIPA), introduced a new second level in the appeals process called a
reconsideration. A reconsideration is a new and impartial review performed by a company
independent of NHIC.

Once a decision has been reached on the redetermination and you are still dissatisfied with the
decision, you may request a reconsideration. Reconsiderations have replaced the hearing level for
claims that are processed on or after January 1, 2006.

Who handles Reconsiderations?

Reconsiderations are not processed by the contractor, NHIC. Reconsiderations are conducted by
the designated Qualified Independent Contractors (QICs). The QIC for California, Maine,
Massachusetts, New Hampshire and Vermont is First Coast Service Options, Inc.

A party must file a written request for a reconsideration with the entity specified in the
Redetermination notice within 180 calendar days of the date the Redetermination decision is
received. If good cause is shown, the QIC may extend the period for filing the request. At this
level of appeal, there is no amount in controversy requirement. A party may file a written
request for reconsideration by either completing Form CMS-20033, Medicare Reconsideration
Request, which is available at
or by submitting a written request that includes the following:

• Beneficiary’s name;
• Beneficiary’s Medicare HIC number;
• Which items or services are at issue and the corresponding date(s) of service;
• Name and signature of the party or representative of the party;
• Name of the Contractor that made the Redetermination; and
• Any additional information you may wish the QIC to consider.

In most cases, the QIC will issue written notice of its reconsideration decision within 60 calendar
days of receipt. If the reconsideration results in supplemental payment to the provider or
supplier, we will issue an electronic or paper RA.

For the second level of appeals, please send your requests to:
First Coast Service Options, Inc
QIC Part B North Reconsiderations
P.O. 45208
Jacksonville, FL 32232-5208

No comments:

Top Medicare billing tips