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Linda Collins Blogger

Request a Telephone Discussion on Claims Appeals

Posted by Linda Collins | November 29, 2016

C2C Innovative Solutions, the Qualified Independent Contractor (QIC), has been testing a way to get claims in appeal at the ALJ level resolved. The demonstration project involved limited claim types (oxygen equipment and diabetic testing supplies) for suppliers in DME MAC regions C and D only.  Selected providers with claims at or above the reconsideration level were given the opportunity to participate in a formal discussion with the QIC reviewers. As a result of the telephone discussions, 80% of the claims in appeal resulted in favorable outcomes for the suppliers.  

The telephone discussion is now open to all DMEPOS suppliers in Region C and Region D. This means if you have appeals at the Reconsideration Level or ALJ Level, you may choose to participate in a formal telephone discussion. Participation is voluntary.

​What does this mean for you?

If your practice has outstanding appeals at the Reconsideration Level or ALJ level, AND you are located in Region C or D, you may request a formal telephone discussion with claims reviewers.  Participation in the telephone discussion does not take away your continued appeal rights. If you do choose to participate, simply complete the Formal Telephone Discussion Request Form and fax to C2C. You will be notified by C2C of the date and time of the telephone discussion.

You may learn more information about this program at Telephone Discussion Demonstration.

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