If you are dissatisfied with a Redetermination, you may go to the next level of appeal, called a Reconsideration. You must file the Reconsideration request within 180 days of the date of the Redetermination decision.
|Time Limit for Filing Request||Monetary Threshold to be Met||Time Limit to Complete Request||Where to File||Forms|
|180 days from Redetermination receipt date||None||60 days from receipt date||Qualified Independent Contractor (QIC)||CMS 20033 - Medicare Reconsideration Request|
A Reconsideration may be requested and submitted to C2C Innovative Solutions, Inc. in one of two ways.
- Complete and submit the standard CMS form, CMS 20033 - Medicare Reconsideration Request
- Submit a written request containing at least the following information:
- Beneficiary's name
- Medicare health insurance claim number
- Specific service(s) and item(s) for which the 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 the Redetermination can appeal a dismissal to the QIC. The Reconsideration request must be filed within 60 days of the dismissal date. You may also ask us to vacate our dismissal. If you would like us to vacate our dismissal, you must file a request within 6 months of the date of receipt of the dismissal letter. In your request, explain why you believe you have good and sufficient cause for failing to include the proper information in your request.
Send Reconsideration requests to:
C2C Innovative Solutions, Inc.
QIC Part B North Reconsiderations
PO BOX 45208
Jacksonville FL 32232-5208
Check Status of Appeal: https://www.q2a.com/
Last Updated Oct 18, 2017