A Reconsideration is the second level of an appeal. Submit a request if dissatisfied with a Redetermination.
|Time Limit for Filing Request||Monetary Threshold to be Met||Time Limit to Complete Appellant's Request||Where to File|
180 days from Redetermination receipt date
|None||60 days from receipt date||Qualified Independent Contractor (QIC)|
A Reconsideration may be requested and submitted to C2C Innovative Solutions, Inc. in one of two ways.
- Complete and submit the CMS 20033 - Medicare Reconsideration Request Form or the Medicare DME Reconsideration Request Form
- Submit a written request containing at least the following information:
- Beneficiary name
- Medicare Beneficiary ID
- Specific service(s) and item(s) for which Reconsideration is requested and specific date(s) of service
- Name and signature of party or representative of party
- Name of contractor that made the Redetermination
Appeal Rights on Dismissals
- Parties to Redetermination can appeal a dismissal to QIC
- Reconsideration request must be filed within 60 days of dismissal date
- Requestor may also ask Noridian to vacate dismissal
- To vacate a dismissal, file a request to Noridian within six months of dismissal letter receipt date. The request must include an explaination detailing why you believe to have good and sufficient cause for failing to include proper information in original redetermination request
Mail Requests to:
C2C Innovative Solutions - QIC DME
PO Box 44013
Jacksonville, Florida 32231-4013
Check the status of a request in the Q2 Administrators Appeals Status Lookup tool.
Contact C2C Innovative Solutions, Inc. at 904-224-7433 with any DME Reconsideration process related inquiries.
Last Updated Feb 13, 2018