The Centers for Medicare & Medicaid Services (CMS) contracts with C2C Solutions, Inc. (C2C) to serve as the national independent entity to resolve payment disputes between Medicare Advantage (MA) organizations, Private Fee for Service (PFFS) plans and deemed and non-contracted providers. C2C brings vast experience in adjudicating Medicare appeals on behalf of CMS. It is important to note that disputes by a Medicare Advantage contracted provider are not handled under this payment dispute resolution process, nor are beneficiary and provider appeals of coverage determination.
Payment disputes that may be resolved by C2C include those instances where reimbursement for the service has been allowed or is included in the reimbursement of another service and may include those instances where the MAO reimbursed a different service than that billed, often referred to as down-coding of claims. To file a request for an independent Payment Dispute Decision (PDD), please use the PDD Request Form. For further guidance in completion of this form, please reference the PDD Form instructions.
Contact us for further information, if needed:
E-mail: PDRC@C2Cinc.com
Phone: (904) 791-6430
Fax: (904) 361-0551
Send requests for an Independent Payment Dispute Decision to:
C2C Solutions, Inc.
Payment Dispute Resolution Contractor
P. O. Box 44017
Jacksonville, FL 32231-4017
Use the following address for all other correspondence:
C2C Solutions, Inc.
Payment Dispute Resolution Contractor
P.O. Box 44035
Jacksonville, FL 32231-4035
Additional Information:
Policies and Procedures Manual
CMS 01/04/10 Payment Dispute Resolution Memo
CMS 12/31/08 Payment Dispute Resolution Memo
CMS Summary of Payment Dispute Resolution Processes