van Halem Group

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Effective September 1, 2019, MAXIMUS Federal will serve as the DME QIC for the entire United States and the U.S. territories. This means that any requests for reconsiderations received on or after September 1, 2019 will be processed by MAXIMUS.

With the switch from C2C to MAXIMUS comes the ability to submit a Reconsideration electronically. MAXIMUS will accept appeals via ESMD to all suppliers through the QIC Appeals Portal.

Redeterminations will continue to be handled by the DME MACs, CGS and Noridian. Instructions on how to file a reconsideration request, including the correct mailing address, will be included on the Medicare Redetermination Notice.

After the DME MAC has made a redetermination decision (first level appeal) for Medicare items or services, a reconsideration (second level appeal) request may be filed as follows:

Requests can be submitted in writing, or via the QIC Appeals Portal at https://qicappeals.cms.gov
Written requests must be filed with MAXIMUS Federal Services at the address listed below. This MAXIMUS address will be indicated on the notice of redetermination.
QIC DME standard reconsideration requests should be mailed to:
Maximus Federal Services, Inc., Medicare DME, 3750 Monroe Avenue, Suite 777, Pittsford, NY 14534-1302

If you need assistance with appeal submissions, we can help! We provide appeal preparation services for your denied claims. For medical necessity denials, an expert Clinical Consultant will draft a summary of the documentation that supports that the services are reasonable and necessary. If additional documentation is necessary, our Medical Records team can collect on your behalf. If the denial is unrelated to medical necessity, an Appeals Coordinator will draft an appeal specifically addressing the denial reasons noted. Our staff will manage the process all the way through the Medicare Appeals Council, if necessary. It is important to note that our staff does not simply submit an appeal request, they address the specific denial reasons.