C2C Innovative Solutions, Inc.: Qualified Independent Contractor (QIC) for Part A East Jurisdictions
Beneficiaries, providers and suppliers have the right to appeal Medicare coverage and payment decisions. Should a provider be dissatisfied with the results of a first-level appeal (redetermination), they may request a second-level decision. All second-level appeals, known as reconsiderations, must be conducted by Qualified Independent Contractors (QICs).
Effective February 14, 2017, C2C Innovative Solutions, Inc. is the Qualified Independent Contractor (QIC) for the East Jurisdiction. The states under the C2C Innovative Solutions, Inc. jurisdiction include:
Alabama, Arkansas, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Louisiana, Maine, Maryland, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Texas, Vermont, Virginia, Virgin Islands and West Virginia.
Please note that a request for reconsideration must be filed within 180 days of the redetermination decision. To file this request, please follow instructions on the Medicare Redetermination Notice (MRN) for the completion of Form CMS-20033 (PDF, 42 KB), or complete a written request including the beneficiary’s name, Medicare Beneficiary Identifier (MBI), dates of service, specific service(s) and item(s) for which reconsideration is requested, name and signature of the party or representative of the party, and the name of the contractor that made the redetermination. This request should be filed with the contractor responsible for the state in which the services were rendered. However, if you are a chain provider, ensure that your request is sent to the QIC who has jurisdiction in the state where the claim was processed.
This reconsideration request, and any other correspondence with C2C Innovative Solutions, Inc., should be addressed to:
C2C Innovative Solutions, Inc.
QIC Part A East Appeals
P.O. Box 45305
Jacksonville, FL 32232–5305
The latest edition of the C2C Appeals Demonstration Newsletter is now available (PDF, 387 KB).