Appeals

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Resolving disputes, rendering impartial appeal decisions, and improving outcomes

Appeals

MAXIMUS is the national leader in providing government health plan enrollees and providers with independent appeal decisions of health insurance denials. Since 1989, the Centers for Medicare and Medicaid Services (CMS) have relied upon us for conflict-free resolution of Medicare appeals.

Today we receive more than 600,000 appeals claims a year for Medicare Parts A, C, and D. We also serve the U.S. Office of Personnel Management Federal Employees Health Benefits Plan (FEHBP), and more than 48 state health insurance regulatory agencies.

The MAXIMUS Federal team of health appeals professionals includes subject matter experts in quality of care, independent review and human subject protection. We employ full-time medical directors, health attorneys, pharmacist-attorneys, nurse-attorneys, nurse professionals and podiatrist-attorneys. Our fully credentialed national panel of more than 500 physicians and other reviewers represent every recognized medical specialty and all major licensed practitioner categories.

Join our National Panel of Health Care Reviewers

MAXIMUS offers a wide range of opportunities for qualified physicians and other practitioners to work as an off-site independent consultant or as an on-site hourly employee in one of our offices. Many of our consultants find case review to be intellectually rewarding and a welcome added dimension to their clinical activities. Learn more...

About MAXIMUS Federal

MAXIMUS Federal Services helps federal government agencies deliver citizen-centric services through improved operational efficiency and better results. We deliver our solutions through the skilled application of government business process management expertise, program experience, subject matter knowledge and technology tools. We focus on the outcomes of federal programs and how to best enhance the experience for citizens receiving government services.