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If a health plan upholds its adverse organization determination, the plan must submit the case file and its decision for automatic review by the Part C Independent Review Entity (IRE). For more information about reconsiderations performed by the Part C IRE, see Section 90 in Chapter 13 of the Medicare Managed Care Manual in the "Related Links Inside CMS" section below. Currently, MAXIMUS Federal Services is the Medicare Advantage (Part C) IRE. More information about the Medicare managed care reconsideration process can be obtained by clicking on the link to MAXIMUS Federal Services in the "Related Links Outside CMS" section below. Fact Sheet: Part C Reconsideration Appeals Data These reports summarize and highlight some of the key data on reconsiderations since the inception of the Medicare prescription drug benefit program on January 1, 2006. To view the Fact Sheets, click on the links in the "Downloads" section below.
Page Last Modified: 12/05/2008 2:34:31 PM
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