- In the Original Medicare (Part A and Part B) appeals process, the second level of appeal, where your appeal is reviewed by a Qualified Independent Contractor (QIC).
- In a Medicare private health plan (Part C) appeals, there are two “reconsideration” phases.
- Reconsideration by the Medicare private health plan. The first step in the appeal of a denial of coverage or denial of payment, in which the plan reviews its initial denial.
- Reconsideration by the Independent Review Entity (IRE). If the plan upholds its initial decision in the redetermination, the appeal is automatically forwarded to the IRE for reconsideration.
- In a Medicare private drug plan (Part D), a review of the plan’s redetermination of its decision to deny coverage or payment. Reconsiderations are conducted by the Independent Review Entity.