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MAXIMUS Federal Services fax number

(585) 869-3365

Part A West QIC (Qualified Independent Contractor)

Used for: Medicare Part A West reconsideration (second-level appeal) filing; expedited reconsideration option available

Fax destination details

Department
Part A West QIC (Qualified Independent Contractor)
Purpose
Medicare Part A West reconsideration (second-level appeal) filing; expedited reconsideration option available
Address
3750 Monroe Avenue, Suite 706, Pittsford, NY 14534-1302
Voice phone
1-866-950-6509

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The request must be in writing and should be made on a CMS form. It must include: 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 dates of service; the name of the party’s representative/billing agent; and the name of the contractor that made the redetermination.

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