After a claim has been denied by a Part A MAC at the first level of appeal (redetermination). The beneficiary or his/her representative may request a reconsideration as indicated by the appeal notice.

A request for a reconsideration must either be made on CMS Form 20033 or written into a letter that must include the following information:

• The beneficiary's name;
• Medicare health insurance claim number (HICN);
• The specific service(s) and item(s) for which the reconsideration is requested and the specific date(s) of service;
• The name of the party or representative of the party; and
• The name of the contractor that made the redetermination

The Qualified Independent Contractor (QIC) that performs Part A reconsiderations is listed below, divided by East and West jurisdiction.

NOTE:
If you have filed an appeal request with a QIC, but have decided to retract that appeal request, you can do so according to 42 CFR § 405.972. 

This regulation states that you may file a written and signed request for withdrawal with the appropriate QIC. The contents of this request for withdrawal must include a clear statement that the appellant is withdrawing the request and does not intend to proceed further with the appeal. The request for withdrawal must also be received in the QIC’s mailroom before the reconsideration is issued.

This section provides specific information for Part A services billed to a Part A MAC:

• Inpatient hospital
• Outpatient hospital
• Skilled Nursing Facility
• Home Health Services
• Hospice

• Standard Appeals
• Expedited Reviews
• Requesting an Appeal
• Current Appeals Status