US · guidance
CMS Pub. 100-04, ch. 29, § 320
Reconsideration - The Second Level of Appeal
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.
History
(Rev. 4380, Issued: 08-30-19, Effective: 07-08-19, Implementation: 10- 01-19)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
8e28692593f2bbc60994dcaf0ec52620948f363e0eb079d9d13e6a85cf2692db
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