Welcome to the Medicare Appeals.

Please visit one of the links below for detailed information regarding the appeals process, downloadable appeals forms, and appeals of Local Coverage Determinations.

The Medicare, Medicaid, and CHIP Benefits Improvement and Protection Act (BIPA) of 2000 included provisions aimed at improving the Medicare appeals process.  Part of these provisions mandate that all second-level appeals, also known as reconsiderations, be conducted by Qualified Independent Contractors (QICs). Please visit this site for more information on QICs.

Right to a Fast-track Review for People in Medicare Advantage Plans (formerly Medicare + Choice): If you are in a Medicare Advantage Plan, you have the right to have a fast-track review by the Quality Improvement Organization (QIO) in your state, if you think you are being discharged from a hospital too early. Beginning January 1, 2004, you also will have access to a quick QIO review when Medicare coverage of your skilled nursing facility, home health agency or comprehensive rehabilitation facility services are about to end. Please visit this site for more information about fast-track reviews, including the service termination notices that providers will deliver, and answers to FAQs (Frequently Asked Questions).

Medicare Appeals and Grievances: provides a short explanation as to how to file an appeal or grievance if you have a complaint.

Medicare Appeals Forms: contains a listing of Medicare appeals forms that you can view and print.

Appeals of Local Coverage Determinations: provides details on how to file a Local Coverage Determination (LCD) appeal.

Leave a Reply

Contact Us | Privacy Statement