Thursday, December 13, 2018

Quality to the Next Level


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Requesting a Part B Appeal

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This process applies to all redetermination decisions processed by MACs on or after Jan. 1, 2006.

After a claim has been denied by a MAC at the first level of appeal (redetermination), the beneficiary or his/her representative may request a reconsideration from a Qualified Independent Contractor (QIC). QICs perform independent, on-the-record reviews of MAC redeterminations. The appellant’s right to a reconsideration will be explained in the redetermination notice.

A request for a reconsideration must either be made on CMS Form 20033 or written into a letter that must include the following information:

  • The beneficiary's name
  • The beneficiary’s Medicare health insurance claim number
  • The specific service(s) and item(s) for which the reconsideration is requested, and the specific date(s) of service
  • The name and signature of the party or representative of the party
  • The name of the contractor that made the redetermination

Qualified Independent Contractor (QIC)

Jurisdiction By States


Part B North Reconsiderations

Mailing Address
C2C Innovative Solutions, Inc.
Part B Reconsiderations
PO Box 45208
Jacksonville, FL 32232-5208

Courier Address
C2C Innovative Solutions, Inc.
Part B Reconsiderations
301 W Bay St., Sixth Floor
Jacksonville, FL 32202-5100

C2C Innovative Solutions Part B North QIC

Alaska, Maine, Vermont, New Hampshire, Massachusetts, Connecticut, Rhode Island, District of Columbia, New York, Pennsylvania, New Jersey, Delaware, Maryland, Ohio, Kentucky, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Missouri, Iowa, Kansas, Nebraska, South Dakota, North Dakota, Wyoming, Montana, Idaho, Washington, Oregon, California, Nevada, Arizona, Utah, Hawaii, Guam, Northern Mariana Islands, American Samoa

Part B South Reconsiderations

Reconsideration Requests

C2C Innovative Solutions, Inc.
Part B South Reconsiderations
PO Box 45300
Jacksonville, FL 32232-5300

Correspondence/Files for Active Cases

C2C Innovative Solutions, Inc.
Part B South Correspondence
PO Box 45301
Jacksonville, FL 32232-5301

Courier Address

C2C Innovative Solutions, Inc.
Part B South Reconsiderations
301 West Bay Street, Suite 600
Jacksonville, FL 32202

ALJ Related Correspondence Address

C2C Innovative Solutions, Inc.
Part B South ALJ Department
P.O. Box 45302
Jacksonville, FL 32232-5302

C2C Innovative Solutions Part B South QIC 

Colorado, Connecticut, New Mexico, Texas, Oklahoma, Arkansas, Louisiana, Mississippi, Tennessee, Alabama, Georgia, Florida, North Carolina, South Carolina, Virginia, West Virginia, Puerto Rico, Virgin Islands


DME Reconsiderations

Mailing Address
C2C Innovative Solutions, DME QIC
P.O. Box 44013
Jacksonville, FL 32231-4163

Courier Address
C2C Innovative Solutions, Inc.
Part B Reconsiderations
301 W Bay St., Sixth Floor
Jacksonville, FL 32202-5100

C2C Innovative Solutions DME QIC

Nationwide

NOTE: If you have filed an appeal request with a QIC, but have decided to retract that appeal request, you can do so according to 42 CFR § 405.972.

This regulation states that you may file a written and signed request for withdrawal with the appropriate QIC. The contents of this request for withdrawal must include a clear statement that the appellant is withdrawing the request and does not intend to proceed further with the appeal. The request for withdrawal must also be received in the QIC’s mailroom before the reconsideration is issued.

  
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