Va. company reaches $25M deal to review Medicare Part D appeals

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Reston, Va.-based MAXIMUS was recently awarded a one-year contract by the Centers for Medicare & Medicaid Services (CMS) to continue it work independently reviewing reconsiderations of beneficiary appeals for the Medicare Part D program.

The work will be done by the company’s Federal Services subsidiary, which has serviced this need since the Medicare prescription program was implemented in 2006.

The contract is valued at $14.3 million, according to MAXIMUS, and includes a nine-month option period, bringing the total deal to $25 million, if that clause is exercised.

MAXIMUS Federal acts as the independent review entity responsible for conducting reconsiderations of adverse coverage determinations and redeterminations made by Part D plans in the Medicare Prescription Drug Program.

Under its current contract, MAXIMUS Federal also conducts reconsiderations of adverse determinations related to prior creditable prescription drug coverage and imposition of a late enrollment penalty under the Medicare Part D program. In addition to Medicare Part D, MAXIMUS Federal also performs reconsiderations nationally as Part A and Part C Qualified Independent Contractors (QICs).

MAXIMUS Chief Executive Officer Richard Montoni said his company “is committed to providing unrivaled service in the administration of government health and human services programs as we seek to expand our client relationships.”

MAXIMUS has more than 6,500 employees in more than 220 offices in the United States, Canada, Australia, the United Kingdom and Israel, offering health and human services program management and consulting services.

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