Demo allows providers to make their case by phone

Tuesday, March 8, 2016

JACKSONVILLE, Fla. – C2C Innovative Solutions, the Qualified Independent Contractor or QIC for the second level of Medicare appeals, is conducting a demonstration project that allows HME providers to discuss denied claims over the phone before a decision is made.

The QIC is conducting the demo project in Jurisdictions C and D for diabetes testing supplies and oxygen equipment, according to its website.

“The Formal Telephone Discussion Demonstration gives suppliers the opportunity to speak with a reconsideration professional to provide verbal testimony and any additional documentation that would assist in a possible favorable demonstration,” it states.

The demo project is limited to a maximum of five claims per National Provider Identifier or NPI.

The QIC expects the demo project to have the following benefits:

·      Provide an opportunity for providers to verbally discuss their case with a decision maker before a QIC decision is made;

·      Allow the appellants to understand what documents the decision maker has in the QIC case file and what documents are missing that 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 prior to the reconsideration decision being made; and

·      Educate suppliers on CMS policies and requirements.

When an appeal is selected for the demo project, the QIC will notify the provider via mail with a scheduled time and date for a telephone discussion. A provider that wants to participate must mail or fax the form enclosed with the letter within the timeframe indicated.