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 a reconsideration request.
- Fill out a "Medicare Reconsideration Request Form." [PDF, 180 KB]
- Submit a written request to the QIC that includes:
- Your name and Medicare Number.
- The specific item(s) or service(s) for which you're requesting a reconsideration and the specific date(s) of service. See your redetermination notice for this information.
- The name of the company that made the redetermination (the company that handles claims 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've 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 redetermination decision from level 1. Send a copy of the "Medicare Redetermination Notice," and any other information that may help your case, 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 can submit additional information or evidence 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 the QIC doesn’t issue a timely decision, you may ask the QIC to move your case to the next level of appeal.
If you disagree with the reconsideration decision in level 2, you have 60 days after you get the "Medicare Reconsideration Notice" to request an Administrative Law Judge (ALJ) hearing.