Tag: C2C Innovative Solutions
CMS switches to C2C Innovative Solutions for Medicare Advantage appeals
April 6, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has awarded the Part C Independent Review Entity (IRE) contract to C2C Innovative Solutions. Effective May 1, 2026, C2C will be responsible for conducting appeals of adverse reconsiderations issued by Part C plans, as well as reviews of plan dismissals of appellant reconsideration requests. The existing Part C IRE, Maximus, will continue to process appeal requests received on or before April 30, 2026. Appeal requests received on...
QIC will transition from C2C to Maximus
June 28, 2019HME News Staff
WASHINGTON - C2C Innovative Solutions has lost its bid to remain CMS's Qualified Independent Contractor for HME, according to AAHomecare.
Jacksonville, Fla.-based C2C has popularized a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases.
Last year, when CMS awarded the new QIC contract to Reston, Va.-based Maximus, C2C protested.
C2C will offer its last phone discussion on Sept. 15 and will complete all decisions...
Jurisdictions A and B: Phone demo is coming your way
October 26, 2018Liz Beaulieu, Editor
WASHINGTON - Christmas has come early for HME providers who have disputed Medicare claims.CMS announced last week that it plans to expand a demonstration project—one that allows providers to speak with reconsideration professionals by phone to try to resolve their denied claims; or re-open denied claims that are stuck at the administrative law judge level—to jurisdictions A and B on Nov. 1.“We've been waiting for this with bated breath,” said Andrea Stark, a reimbursement...
CMS expands phone demo
October 23, 2018HME News Staff
JACKSONVILLE, Fla. - CMS will expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases to jurisdictions A and B on Nov. 1.
The agency cited “strong support from the supplier community and the initial success of the demonstration” as reasons to expand the phone demo.
“Effective on or after Nov. 1, the DME QIC will offer telephone discussions and/or re-openings to DME suppliers within the DME...
GAO sides with C2C on QIC contract
August 24, 2018HME News Staff
WASHINGTON - The Government Accountability Office agrees that CMS failed to properly assess “potential organizational conflict” when the agency awarded Maximus the DMEPOS QIC contract. The GAO's decision* comes after C2C Solutions, the current QIC contractor, protested the award. The GAO's decision sustains C2C's protest. “Protest that the agency failed to evaluate a potential impaired objectivity organizational conflict of interest is sustained where the awardee's...
Stakeholders fear QIC switch
April 20, 2018Liz Beaulieu, Editor
YARMOUTH, Maine - Stakeholders are not happy that C2C Innovative Solutions appears to be losing its gig as the Qualified Independent Contractor for HME.
Jacksonville, Fla.-based C2C has popularized a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases. In 2017, 64% of claims that were involved in the demo were found fully favorable and 3% were found partially favorable, AAHomecare recently reported.
“C2C has...
Update: C2C phone demo
April 12, 2018HME News Staff
WASHINGTON - C2C Innovative Solutions, the QIC contractor, reopened 54,138 claims and withdrew 27,132 claims from the Administrative Law Judge backlog in 2017, according to a bulletin from AAHomecare. Of those who participated in the telephone demonstration, 64% of the claims were found fully favorable and 3% were found partially favorable. AAHomecare also reports that C2C has also lost their QIC contract, a decision it expects the contractor to appeal.
Appeals update: Pressure mounts to expand phone demo
December 15, 2017Liz Beaulieu, Editor
WASHINGTON - CMS is considering expanding a demonstration project to jurisdictions A and B that allows providers to speak with reconsideration professionals by phone to try and resolve their appeals at the second level, stakeholders say.
After hearing testimony from Ronda Buhrmester at a recent Small Business Administration hearing, CMS responded in a letter, saying it “concurs with the noted initial benefits of this demonstration and is in discussions regarding possible expansions to jurisdictions...
Industry to CMS: Build out phone demo
February 24, 2017Liz Beaulieu, Editor
WASHINGTON - Industry stakeholders are throwing their support behind expanding a demonstration project that allows providers to speak with reconsideration professionals by phone to try and resolve their appeals.
AAHomecare on Feb. 22 submitted comments to CMS, recommending that the agency also consider applying the phone demo to the first level of appeals. Currently, it applies only to the second level of appeals.
“Although the demonstration at the second level of appeals has been a positive...
CMS contractor expands phone demo
November 4, 2016Liz Beaulieu, Editor
JACKSONVILLE, Fla. - C2C Innovative Solutions, the contractor handling the second level of the Medicare appeals process, has received the green light from CMS to expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases.
C2C, CMS's Qualified Independent Contractor or QIC, received word from the agency on Nov. 1 that it can open the demo to all product categories, with the exception of power mobility devices,...