Beneficiary Complaint: Failure to Respond to the Final Initial

5055.7 – Beneficiary Complaint: Failure to Respond to the Final Initial Determination and Right to Reconsideration (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) For instances when a practitioner/provider and the beneficiary fail to request a reconsideration following notification by phone and receipt of the QIO’s Final Interim Determination (Appendix 5-4.1) and the Final Determination Letter to Beneficiary (Appendix 5-4.2) within the three (3) calendar-day period, the QIO shall follow the procedures in §5060.4, “Beneficiary Complaint: Procedures for Closing a Complaint Review” for closing as a completed case in the CMS- designated case review system. NOTE: The QIO may pursue, or recommend to the appropriate Quality Innovation Network - Quality Improvement Organization (QIN –QIO), in accordance with §5125 if deemed appropriate.