A QIC is an independent contractor that didn't take part in the level 1 decision. The QIC will review your request for a reconsideration and make a decision.
The redetermination notice you got in level 1 has directions for you to file a request for reconsideration.
There are 2 ways to submit reconsideration request.
- Fill out a "Medicare Reconsideration Request Form."
- Submit a written request to the QIC that includes:
- Your name, address, and Medicare number.
- The items or services for which you're requesting a reconsideration and the specific dates of service. See your redetermination notice for this information.
- The name of the company that made the redetermination (the company that handles bills for Medicare). See the MSN or the redetermination notice for this information.
- An explanation of why you disagree with the redetermination decision.
- Your signature. If you have appointed a representative, include the name and signature of your representative.
No matter how you choose to request a reconsideration, the request should clearly explain why you disagree with the decision from level 1. Send a copy of the "Medicare Redetermination Notice" with your reconsideration request to the QIC. You must send your request to the QIC that will handle your reconsideration. The QIC's address is listed on the redetermination notice. You should also include any other information that may help your case with your request. You can submit additional information after the reconsideration request has been filed, but it may take longer for the QIC to make a decision.
In most cases, the QIC will send you a written response called a "Medicare Reconsideration Notice" about 60 days after the QIC gets your appeal request.
If you disagree with the reconsideration decision in level 2, you have 60 days after you get the "Medicare Reconsideration Notice" to request a hearing by an Administrative Law Judge (ALJ).