PAE Reopening Process

PAE Reopening Process

As a component of the Appeals Demonstration, C2C will conduct analysis on completed unfavorable claims dated on or after Jan. 1, 2013, and currently pending a decision at the Administrative Law Judge (ALJ). As a result of the analysis, C2C will present its findings and a list of claims of potential reopenings to the respective providers.

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 received and determine if a reopening is warranted. The reopening shall only occur upon receipt of and C2C’s verification of the missing or otherwise relevant documentation that would yield the favorable decision. Participants will receive a letter notifying them if the case can or cannot be reopened after C2C has completed this review.

  1. 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, C2C will work with the ALJ to remand the case back to the QIC for processing of the reopening.
  2. If a provider no longer wishes to continue the appeal pending before the ALJ, C2C can assist with withdrawing the appeal. C2C will furnish the provider with a withdrawal request spreadsheet, along with form HHS-730 (Withdrawal of request for an Administrative Law Judge (ALJ) Hearing). If you have questions regarding the withdrawal process, you may call us at (904) 224-7371

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

C2C Innovative Solutions, Inc.
QIC PAE– Reopening Process Demonstration
P.O. Box 45310
Jacksonville, FL 32232-5310
Telephone: (904) 224-7371
Fax: 904-224-2732

 

Feedback:

To provide feedback to C2C Innovative Solutions, Inc. regarding your Telephone Discussion or the reopening process, please send your email to: ADemoFeedback@c2cinc.com

For information about the availability of auxiliary aids and services, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.

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