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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 of the party or representative of the party
- The name of the contractor that made the redetermination
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Qualified Independent Contractor (QIC)
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Jurisdiction By States
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Part B North Reconsiderations
Requests By Fax or Secure Online Portal
Fax your appeal to the number at QIC Part B North OR Submit your appeal and documentation to C2C's secure portal through www.c2cinc.com.
Requests By Mailing Address
C2C Innovative Solutions, Inc.
Part B North 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
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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
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Part B South Reconsiderations
Requests By Fax or Secure Online Portal
Fax your appeal to the number at QIC Part B South OR Submit your appeal and documentation to C2C's secure portal through www.c2cinc.com.
Requests By Mail
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 44006
Jacksonville, FL 32232-4006
C2C Innovative Solutions Part B South QIC
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Colorado, Connecticut, New Mexico, Texas, Oklahoma, Arkansas, Louisiana, Mississippi, Tennessee, Alabama, Georgia, Florida, North Carolina, South Carolina, Virginia, West Virginia, Puerto Rico, Virgin Islands
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DME Reconsiderations
Mailing Address
MAXIMUS Federal DME QIC
3750 Monroe Avenue, Suite 777
Pittsford, NY 14534
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Nationwide
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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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Part B / DME Appeals
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This section provides
specific information for Part B and Durable Medical Equipment (DME) services
billed to a Part B MAC.
These services
include:
- Physicians’ services
- Non-physician practitioners’
services
- Clinical
laboratory services
- Durable
Medical Equipment (wheelchairs, hospital beds, walkers, oxygen,
etc.)
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