US · guidance
CMS Pub. 100-06, ch. 3, § 200.4.7
QIC Remands on Dismissals
When the QIC performs its review of the dismissal, it will decide if the dismissal was correct.
If it determines that the contractor incorrectly dismissed the redetermination, it will vacate the
dismissal and remand the case back to the Contractor for a redetermination. When the QIC
remands an appeal, it is mandatory for the Contractor to issue a new redetermination decision
in accordance with Publication 100-04, Medicare Claims Processing Manual, and Chapter 29.
A. Contractors shall change the Reconsideration appeal status back to a Redetermination
appeal status until a new decision is rendered.
1. Update the AR status within eight (8) business days from the email receipt date
(from appeals) on all QIC remand notifications.
2. Contractors shall follow the Redetermination instructions specified in Chapter 3, §
200.3 (A) after the review is completed.
3. For additional guidance, refer to 42 CFR §§405.379, 405.952 and 405.972 and
publication 100-04, Medicare Claims Processing Manual Chapter 29 - Appeals of
Claims Decisions
History
(Rev. 12261; Issued:09-22-23, Effective: 12-11-23; Implementation:12-11-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
8acbd23dd407b1b9d071d96bbc607ddbdbbc6a7ad9e34baea2b517d00f8b810f
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