Part A West

When to File a Part A West Standard Appeal

After a Part A or Home Health and Hospice Medicare Administrative Contractor (MAC) has made a redetermination (first level appeal) decision for fee-for-service Medicare items or services, you may file a reconsideration (second level appeal) request with Maximus as follows:

• The request must be filed with Maximus and can be submitted via the following methods:
  • QIC Appeals Portal at QIC Appeals Portal (opens in new tab)
  • In writing, mailed to: Maximus QIC Part A West 3750 Monroe Ave Suite 706 Pittsford, NY 14534-1302
  • Via secure fax at 1-585-869-3346
• The request must be in writing and should be made on a standard CMS form (opens in new tab). A written request that is not made on a standard CMS form (opens in new tab) is accepted if it contains the same required elements as follows:
  • The beneficiary’s name
  • Medicare Beneficiary Identifier or Medicare health insurance claim number
  • 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 the representative/billing agency (opens in new tab) of the party
  • The name of the contractor that made the redetermination

QIC Appeals Portal (opens in new tab)

For the status of your appeal, please use the appeal status lookup tool: Appeal Status Lookup Tool (opens in new tab)

When to File a Part A West Expedited Appeal

After a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) has made a redetermination (first level appeal) decision on notice of discharge or service termination by a Medicare covered skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice agency, you may file an expedited reconsideration (second level appeal) request as follows:

• A beneficiary who wishes to obtain an expedited reconsideration must submit a request for reconsideration to Maximus, in writing via fax or verbally by telephone, by no later than noon of the calendar day following initial notification (by telephone or in writing) of the BFCC-QIO's determination.
• The request must be filed with Maximus and can be submitted via the following methods:
  • By phone toll free at 1-866-950-6509
  • Via secure fax at 1-585-869-3365