QIC Part A East

Effective February 14, 2017, 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.

Beginning February 14, 2017, for Part A East expedited reconsideration requests, please call toll free 1-855-371-5817 by no later than noon of the calendar day following the notice by the QIO of its redetermination decision.

Beginning February 14, 2017, for Part A East standard reconsideration requests, please include all of the following items in your request for the reconsideration:

1. The Medicare beneficiary's name
2. The Medicare beneficiary's health insurance claim number (HICN) or Medicare number
3. Specific service(s) and item(s) for which the reconsideration is being requested, and the specific date(s) each of those item(s) or service(s) were provided
4. The name of the party (appellant) or the name of the authorized representative of the party (appellant). Note: As of July 8, 2019, the signature of the party or the signature of the authorized representative of the party is no longer a requirement for a request for reconsideration.
5. The name of the Medicare contractor that rendered the Part A claim redetermination (first-level appeal decision)

Fillable Reconsideration Request Form is available for use.

Contact Us

For Expedited appeals, please call 1-855-371-5817.

Access FAQs on these Electronic Options for Submitting Standard Medicare Fee-For-Service (FFS) Second-Level Appeals-Reconsiderations.

For Standard appeals only:

Choose one of these three ways to submit your appeal:

• You may securely fax your appeal to 904-539-4074 OR
• You can submit your appeal and documentation through our appeals portal (Access a User's Guide.) OR
• You may mail your appeal to:
  C2C Innovative Solutions - QIC Part A East
  PO Box 45305
  Jacksonville, Florida 32232-5305

If you have questions about the QIC Part A East appeals process, you may call us at 904-224-7446.

If an enrollee would like to appoint a person to request an appeal on his or her behalf, the following form may be used: Appointment of Representative Form CMS 1696 (AOR).