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  • Maximus Reconsideration Process Manual

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MAXIMUS Federal Services Medicare Health Plan Reconsideration Process Manual Medicare Managed Care Reconsideration Project MAXIMUS Federal Services 3750 Monroe Ave. Ste. 702 Victor, New York 14534-1302.

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If you disagree with the initial decision from your plan (also known as the organization determination), you or your representative can ask for a reconsideration (a second look or review).

A redetermination is a review of the claim by Medicare Administrative Contractor (MAC) personnel not involved in the initial claim determination.

Once you get a decision, what you need to do after the decision. The two avenues we've seen are to appeal it, or to ask for a reconsideration. ... If you're asking for a reconsideration, you're not appealing. It's sort of a new claim, a reopened claim, whatever you want to call it.

Any party to the redetermination that is dissatisfied with the decision may request a reconsideration. A reconsideration is an independent review of the administrative record, including the initial determination and redetermination, by a Qualified Independent Contractor (QIC).

A redetermination is a review of the claim by Medicare Administrative Contractor (MAC) personnel not involved in the initial claim determination.

Fill out a "Redetermination Request Form [PDF, 100 KB]" and send it to the Medicare contractor at the address listed on the MSN. Follow the instructions for sending an appeal.

If your exception request is denied, your plan should send you a Notice of Denial of Medicare Prescription Drug Coverage. You have 60 days from the date listed on this notice to begin the formal appeal process by filing an appeal with your plan.

Verbal expedited appeals can be directed to the Maximus Federal Services West expedited toll free at 1-866-950-6509. Written expedited appeal may be faxed to Maximus Federal Services at 1-585-869-3365.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232