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:
- The Medicare beneficiary's name
- The Medicare beneficiary's health insurance claim number (HICN) or Medicare number
- 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
- 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.
- 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.
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).