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Once the benefit request is received by the IRE, the IRE must make its decision and provide written notice of its decision as quickly as the enrollee's health requires, but no later than 72 hours for expedited requests or 7 calendar days for standard requests from receipt of the request. How the IRE Processes Reconsideration Requests The Part D QIC Searchable Website Database, containing all Part D appeals data can be found at the following address. Also provided in the " Related Links" section below is a link to the Part D QIC Reconsideration Procedure Manual (click on the " Part D QIC Manual" link). To access the IRE’s website, use the link in the " Related Links" section below. The IRE’s website has many features that allow enrollees, enrollee representatives, plan sponsors, and physicians or other prescribers to obtain information regarding the Medicare Part D reconsideration process. Reconsideration appeals requests must be sent to the IRE, C2C, at one of the following addresses:Ĭourier or Tracked Mail such as FedEx or UPS: If a Medicare prescription drug (Part D) plan enrollee wants to appeal a Part D plan's unfavorable or partially favorable redetermination, the appeal request must be sent to the IRE.

An enrollee, an enrollee's representative, or an enrollee's prescriber may use the model "Request for Reconsideration of Medicare Prescription Drug Denial" form to request a reconsideration with the IRE (using the left navigation menu, go to the " Forms" webpage).

All requests must be made in writing, which includes by fax.

The request must be filed with the IRE within 60 calendar days from the date of the plan sponsor's redetermination decision notice.

How to Request a ReconsiderationĪn enrollee, an enrollee's representative, or an enrollee's prescriber may request a standard or expedited reconsideration. is the current Part D IRE, effective February 1, 2021.įor more information about appointing a representative, see section 20 in the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance, using the link in the " Downloads" section below. If a Part D plan sponsor issues an unfavorable or partially favorable redetermination decision, the enrollee, the enrollee's representative, or the enrollee's prescriber may appeal the decision to the Independent Review Entity (IRE), also commonly called the Part D Qualified Independent Contractor (QIC), by requesting a reconsideration.