As a component of the Formal Telephone Discussion Demonstration, C2C is also conducting analysis on previously completed unfavorable reconsideration decisions dated on, or after, January 1, 2013, and that are from the respective DME MAC Jurisdictions C (CGS) and D (Noridian). 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 QIC, but yet to be appealed to the Administrative Law Judge (ALJ), as well as cases that have been appealed to the ALJ and are currently pending an ALJ decision. If additional documentation is needed to support a favorable outcome through the reopenings process, C2C shall provide written notification to suppliers and what documentation is required to support a favorable decision under this demonstration.
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 C2C’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 formal telephone discussion for claims that are selected for participating suppliers.
C2C Innovative Solutions, Inc.
QIC DME- Reopening Process Demonstration
P.O. Box 44050
Jacksonville, FL 32231-4050
Telephone: (904) 224-7349
Fax: (904) 224-2711