How to File an Appeal

For QIC DME Jurisdictions: You may file a reconsideration request with MAXIMUS Federal Services if your claim for Medicare DME services was denied. Your reconsideration request will be handled by MAXIMUS Federal Services.

Standard Reconsiderations

After a DME MAC has made a redetermination (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
  • The request must be in writing and submitted via a standard CMS form, or alternatively, the request must contain:
    • The beneficiary’s name;
    • 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; and
    • The name of the contractor that made the redetermination.

 

Reconsideration Request form for Standard Appeals

Click here to download request form.

Medicare Durable Medical Equipment (DME) Appeals