Direct Medical Equipment Appeals Demonstration

C2C Innovative Solutions, Inc. (C2C) is a Qualified Independent Contractor (QIC) for Medicare Part A for 26 eastern states, Washington D.C. and two U.S. territories. This jurisdiction also includes reconsiderations involving MSP recoveries. The jurisdiction is referred to as QIC Part A East.

DME Telephone Discussions

The Telephone Discussions give suppliers the opportunity to speak with reconsideration professionals in order to present the facts of the case and provide additional documentation to support a favorable determination. It is expected that the Telephone Discussion Demonstration will yield the following benefits:

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  • Provides an opportunity for the DME supplier community to verbally discuss the case with a decision maker before a QIC decision is made;

  • Informs the supplier what documents are present in the QIC case file and what documents are needed and critical to the outcome of a case;

  • Provides the opportunity to fax or transmit through other secured media additional documentation that supports a favorable appeals decision to the QIC decision maker prior to the reconsideration decision being made; and

  • Assists and educates suppliers on CMS policies and requirements.

 

If an appeal is selected for the Telephone Discussion Demonstration, the QIC will notify the supplier via mail with a scheduled time and date for the Telephone Discussion. Participation in this demonstration is voluntary. In order to participate, the supplier will need to reply by returning the form enclosed with the election acknowledgement letter contact information form via mail or fax within the timeframe indicated in the letter. If you have questions regarding the DME Telephone Discussion Demonstration, you may call us at (904) 224-7349.

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Reopening Process

As a component of the Telephone Discussion Demonstration, C2C is also conducting analysis on previously completed unfavorable reconsideration decisions dated on, or after, January 1, 2013. As a result of the analysis, C2C is working to identify potential appeals for reopening that can now be resolved favorably through the reopening process under this demonstration.

 

The universe of appeals which may be reopened by C2C under this demonstration may include cases that have been closed by the Qualified Independent Contractor (QIC) in the past 60 days and have not yet been appealed to the Administrative Law Judge (ALJ), as well as cases that have been appealed to the ALJ and are currently pending. As a reminder, if you intend to submit an appeal to the ALJ, it must be submitted within 60 days from the QIC decision date.

 

After the QIC receives the requested documentation, the QIC will review the materials received to confirm all requested documentation was submitted, and will determine if a reopening is warranted. The reopening shall only occur upon receipt of, and C2Cā€™s verification of, the missing or otherwise relevant documentation that would yield a favorable decision. Participants will receive a letter notifying them if the case can or cannot be reopened after C2C has completed this review.

If the case or cases are currently pending at the ALJ, C2C will review the documentation received, and if it is determined that the claim can be resolved favorably through a QIC reopening under this demonstration, C2C will work with the ALJ to remand the case back to the QIC for processing of the reopening.

 

Additional details regarding the reopening process will be provided by C2C during the telephone discussion for claims that are selected for participating suppliers.

 

If a supplier has changed their mailing address since the Reconsideration was requested to and completed by the QIC, please email your new mailing address and a contact telephone number to DMEPDFeedback@c2cinc.com.

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Durable Medical Equipment Forms

Telephone Discussion Cover Letter

Reopening Process Cover Letter

Telephone Discussion Contact Form

Withdraw Hearing Request, Form HHS 730

Contact:
Schedules:

GSA Schedule 36

GSA Professional Services Schedule (PSS)

Accreditations:

ISO 9001: 2015 Registered

URAC Internal/External

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DUNS:

929125818

NAICS Codes: 

541611, 541612, 541614, 541618, 541990, 923120, 524291, 524298, 561110, 561421, 561439, 561499, 518210, 621111, 923140