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MAXIMUS Federal Services fax number
(585) 869-3365
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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
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
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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