QIC DME: Formal Telephone Discussion Demonstration
Expansion: Expanding claim types
C2C Innovative Solutions is conducting a voluntary Formal Telephone Discussion Demonstration. The Formal Telephone Discussion Demonstration gives suppliers the opportunity to speak with reconsideration professionals in order to present the facts of the case and provide additional documentation to support a favorable determination. It is expected that the Formal Telephone Discussion Demonstration will yield the following benefits:
- Provide an opportunity for the DME supplier community to verbally discuss their case with a decision maker before a QIC decision is made;
- Inform the supplier what documents are present in the QIC case file and what documents are needed and are critical to the outcome of a case;
- Provide the opportunity for additional documentation that supports a favorable appeals decision to be faxed or transmitted through other secured media to the QIC decision maker prior to the reconsideration decision being made; and
- Assist and educate suppliers on CMS policies and requirements.
The Formal Telephone Discussion Demonstration is currently limited to appeals submitted by suppliers within Durable Medical Equipment (DME) MAC Jurisdictions C (CGS) and D (Noridian). Effective on, or after, October 31, 2016, the service types under this demonstration include all appeal types, with exception to claims or suppliers that are already subject to another CMS initiative (e.g. prior authorization for power mobility devices (PMDs) or the settlement conference facilitation (SCF) process).
If an appeal is selected for the Formal Telephone Discussion Demonstration, the QIC will notify the supplier via mail with a scheduled time and date for the Formal Telephone Discussion to be conducted. Participation in this demonstration is voluntary. Therefore, in order to participate, the supplier will need to reply by returning the form enclosed with the election acknowledgement letter contact information form via mail or fax within the time frame indicated in the letter.
If you have questions regarding the DME Formal Telephone Discussion Demonstration, you may call us at (904) 224-7349.
C2C Innovative Solutions, Inc.
QIC DME- Formal Telephone Discussion Demonstration
P.O. Box 44044
Jacksonville, FL 32231-4044
Telephone: (904) 224-7349
Fax: (904) 224-2711