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Current Style: Standard
MAXIMUS Federal Services is a Qualified Independent Contractor (QIC) for Medicare Durable Medical Equipment (DME) claims for all DME jurisdictions. For information on how to file a DME reconsideration request please refer to “How to file an appeal” under the Medicare Appellants option.
On January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) implemented the Qualified Independent Contractor (QIC) Formal Telephone Discussion and Reopening Process Demonstration (referenced here as the Demonstration) with a goal of engaging suppliers and improving the claim submission process for durable medical equipment (DME). As of September 1, 2019, MAXIMUS Federal will begin processing new reconsiderations of DME appeals (the second level of appeal for denied claims) and will continue the existing Demonstration activities for these appeals as appropriate.
The Demonstration initially focused on claims originating in DME Medicare Administrative Contractor (MAC) Jurisdictions C and D. On November 1, 2018, the Demonstration expanded to include most claims originating in MAC Jurisdictions A and B as well. Claims in Jurisdictions A and B for glucose/diabetic testing supplies are not currently eligible for this Demonstration. (Note that claims for glucose/diabetic testing supplies continue to remain eligible for Jurisdictions C and D.) In addition, claims from any jurisdiction that are subject to other CMS initiatives (e.g., authorization for power mobility devices (PMDs), the settlement conference facilitation (SCF) process, etc.) are not eligible for the Demonstration.
The goal of the Demonstration is to educate suppliers about Medicare policies and regulations in order to improve their future billing. The Demonstration has two components:
Participation in the Demonstration process will have the following benefits:
For more information about the Demonstration, please follow the links or contact:
MAXIMUS Federal
Formal Telephone Discussion and Reopening Process Demonstration
3750 Monroe Avenue, Suite 777
Pittsford, NY 14534-1302
Phone: 585-348-3202
Fax: 17204627581
Email: MaximusQICDemo@maximus.com
CMS has additional information about the demonstration on its website. Read more about reconsiderations and the Demonstration here.