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Level 2: Reconsideration
Filing a Request for a Reconsideration
The request for a reconsideration made by a beneficiary, provider, supplier, or State must be filed with the QIC specified in the redetermination notice. A request from a provider, supplier, or State must be made in writing either on the Form CMS-20033 (the reconsideration request form included with the redetermination), or must contain the following items:
Time Limit for Filing a Request for a Reconsideration
A party must file a request for reconsideration within 180 days of the date of receipt of the notice of the redetermination. The date of filing for requests filed in writing is defined as the date received by the QIC in their corporate mailroom. If the party has filed the request in person with the QIC, the filing date is the date of filing at such office, as evidenced by the receiving office’s date stamp on the request. If the party has mailed the request for reconsideration to a CMS, SSA, RRB office, or another government agency in good faith within the time limit, and the request did not reach the appropriate QIC until after the time period to file a request expired, the QIC considers the request as timely filed. Likewise, if the request is filed with CMS, SSA, RRB, or another government agency in person, the QIC considers the request as timely filed.
QIC Review of a Dismissal of a Redetermination Request
If a MAC has dismissed a redetermination request, any party to the redetermination has the right to appeal a dismissal of a redetermination request to a QIC if they believe the dismissal is incorrect. The request for review must be filed with the QIC within 60 days after the date of receipt of the dismissal. When the QIC performs its review of the dismissal, it will only decide on whether or not the dismissal was correct. If it determines that the MAC incorrectly dismissed the redetermination, it will vacate the dismissal and remand the case to the MAC for a redetermination. See “First Level of Appeal” webpage (left navigation bar) for more information on MAC dismissals.
Dismissal of a Reconsideration Request
A QIC may dismiss a reconsideration request in the following instances:
• If the party (or appointed representative) requests to withdraw the appeal; or
• If there are certain defects, such as
o The party fails to file the request within the appropriate timeframe and did not show (or the QIC did not accept) good cause for late filing
o The representative is not appointed properly
o The requestor is not a proper party
Parties to a QIC's dismissal of a request for reconsideration have 2 options if they disagree with the dismissal:
• Request review of the dismissal by an Administrative Law Judge (ALJ,) or attorney adjudicator at the Office of Medicare Hearings and Appeals (OMHA)
• Request that the QIC vacate the dismissal
Reconsideration Decision Notification
The reconsideration decision will contain detailed information on further appeals rights, where applicable. Generally, the QIC will send this decision to all parties within 60 days of receipt of the request for reconsideration. If the QIC is unable to complete its reconsideration within this timeframe (with exceptions for extensions for additional evidence submissions and late filing), the QIC must send a notice to the parties and advise the appellant of the right to escalate the appeal to OMHA. If the party chooses to escalate the appeal to OMHA, a written request must be filed with the QIC in accordance with instructions on the escalation notice.