Reconsideration - The Second Level of Appeal

320 - Reconsideration - The Second Level of Appeal (Rev. 4380, Issued: 08-30-19, Effective: 07-08-19, Implementation: 10- 01-19) Section 1869 of the Act entitles any individual dissatisfied with the A/B MAC (A)’s, (B)’s, (HHH)’s, or DME MAC’s redetermination to file a request, within 180 days of receipt of the redetermination, for a reconsideration. In accordance with §1869(c), reconsiderations are to be processed within 60 days by entities called qualified independent contractors (QICs). CMS is required to contract with no fewer than four QICs. When a claim is denied on the basis of §1862(a)(1)(A) of the Act, the QIC reconsideration will consist of a panel of physicians and other health professionals. When the panel reviews services or items rendered by a physician or ordered by a physician, the panel will consist of at least one physician.