Second Level of Appeal: Reconsideration with the Qualified Independent Contractor

If you are dissatisfied with an initial claim determination, you have the right to request an appeal of Medicare coverage and payment determinations.

There are five levels in the appeals process. Each level in the appeals process must be completed before proceeding to the next level.

The Five Levels

1. First Level of Appeal: Redeterminations are processed by Palmetto GBA
2. Second Level of Appeal: Reconsiderations are processed by a Qualified Independent Contractor (QIC). The Part B QIC is C2C Innovative Solutions, Inc. Their address can be found below.
3. Third Level of Appeal: Hearing by an Administrative Law Judge (ALJ) in the Office of Medicare Hearings and Appeals
4. Fourth Level of Appeal: Review by the Medicare Appeals Council
5. Fifth Level of Appeal: Judicial Review in Federal District Court

Palmetto GBA has recently seen some reconsideration requests incorrectly mailed to our office instead of being sent to the Qualified Independent Contractor (QIC). If we receive a request for Reconsideration in our office, we do refer your appeal to the QIC, but this can cause delays in the processing of your second level appeal.

Part B Reconsiderations should be mailed to the QIC at:

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

If you are dissatisfied with the first level redetermination decision, QIC reconsideration may be requested within 180 days from the date of receipt of the redetermination notice. Your redetermination notice will provide information about any further appeal rights.

To exercise your right to a second level appeal, you must file a written request. Your request must be received by the QIC at the address given in your redetermination notice within 180 days of receiving the redetermination decision. You may request an appeal by using the form enclosed with your redetermination decision letter. Your reconsideration request should be mailed to the address of C2C Innovative Solutions Inc. provided on the request form and noted above.

You may also use CMS form 20033 (PDF, 42 KB) — Medicare Reconsideration Request Form — Second Level of Appeal which is available on the CMS.gov website.  

A link to this form is also found on the Palmetto GBA website in the Forms/Tools section.  

We recommend using a form for your reconsideration request. But if you choose not to use a form, your request must be in writing and contain the following information:

• The beneficiary’s name
• Medicare Beneficiary Identifier (MBI/HIC)
• 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 filing the request and
• The name of the contractor that made the redetermination

All Part B requests for reconsideration must be mailed to the C2C Innovative Solutions, Inc., at the address above, and be accompanied by any additional documentation to support your request. We strongly recommend that you include a copy of your redetermination notice with your request.