Original Medicare (Fee-for-service) Appeals Enhanced Opportunity for Submission of 2nd Level Appeals, Reconsiderations

Qualified Independent Contractors (QICs) that process 2nd level Medicare Fee-For-Service (FFS) claim appeals, reconsiderations, on behalf of the Centers for Medicare & Medicaid Services (CMS) have established alternative communication mediums for CMS stakeholders to submit reconsideration requests and related documentation to the QIC. The websites for the respective QIC jurisdictions contain instructions to stakeholders for electronic (e.g., fax or portal) submission of reconsideration requests or documentation. Guidance regarding the options for submitting reconsiderations and related documentation is also summarized by QIC jurisdiction in the table below.

QIC JurisdictionContractorOptions for Submission of 2nd Level Appeals & Related Documentation to the QIC
Part A EastC2C Innovative Solutions, Inc.Requests can be submitted in writing, via fax to 904-539-4074, or via the Part A East QIC Appeals Portal at https://www.c2cinc.com/QIC-Part-A-East. For beneficiary expedited reconsiderations requests (e.g., service termination denials) following an unfavorable expedited redetermination conducted by a Qualified Improvement Organization, please call 1-855-371-5817.
Part A WestMAXIMUS Federal ServicesRequests can be submitted in writing, via the Part A West QIC Appeals Portal at https://qicappeals.cms.gov, or by fax to 585-869-3346. For beneficiary expedited reconsiderations requests (e.g., service termination denials) following an unfavorable expedited redetermination conducted by a Qualified Improvement Organization, please continue to call 1-866-950-6509.
Part B NorthC2C Innovative Solutions, Inc.Requests can be submitted in writing, via fax to 904-539-4081, or via the Part B North QIC Appeals Portal at https://www.c2cinc.com/QIC-Part-B-North.
Part B SouthC2C Innovative Solutions, Inc.Requests can be submitted in writing, via fax to 904-539-4090, or via the Part B South QIC Appeals Portal at https://www.c2cinc.com/QIC-Part-B-South.
Durable Medical Equipment (DME)MAXIMUS Federal ServicesRequests can be submitted in writing, via the DME QIC Appeals Portal at https://qicappeals.cms.gov/, or by fax to 585-869-3314.
DME Appeals DemonstrationMAXIMUS Federal ServicesResponses to phone discussion scheduling letters and submission of documentation related to a phone discussion or Demonstration reopening can be submitted in writing, via the DME QIC Appeals Portal at https://qicappeals.cms.gov/, or by fax to 585-869-3315.
Part A East Appeals DemonstrationC2C Innovative Solutions, Inc.Responses to phone discussion scheduling letters and submission of documentation related to a phone discussion or Demonstration reopening can be submitted in writing or via fax to 904-224-2732 or via the Part A East QIC Appeals Portal at https://www.c2cinc.com/QIC-Part-A-East.

Note: implementation of these alternative mechanisms does not preclude CMS stakeholders from ongoing submission of 2nd level appeals via hard copy mail.

Another ongoing, alternative method to submit electronic 2nd level Medicare FFS Part A and Home Health and Hospice (HH+H) claim appeal reconsiderations, is through your Medicare Administrative Contractor (MAC) portal. The table below summarizes MACs that currently support electronic 2nd level Part A and HH+H reconsideration intake automatically routed to the QIC.

MAC Jurisdiction /Contractor2nd Level Appeal Claim Type Accepted /Applicable StatesMAC Provider Portal
JK National Government Services, Inc.Part A: Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont HH+H: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermonthttps://connex.ngsmedicare.com/
JM Palmetto GBA, LLCPart A: North Carolina, South Carolina, Virginia, West Virginia  HH+H: Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Texashttps://palmettogba.com/eservices
JJ Palmetto GBA, LLCPart A: Alabama, Georgia, Tennesseehttps://palmettogba.com/eservices
J15 CGS Administrators, LLCPart A: Kentucky, Ohio HH+H: Delaware, District of Columbia, Colorado, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia, and Wyominghttps://www.cgsmedicare.com/myCGS/Index.html

Submission options can be found here: https://www.cms.gov/Medicare/Appeals-and-Grievances/OrgMedFFSAppeals/index

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