C2C Innovative Solutions Information

C2C Innovative Solutions Information

03/01/16

C2C Innovative Solutions is conducting a voluntary Formal Telephone Discussion Demonstration. The Formal Telephone Discussion Demonstration gives suppliers the opportunity to speak with a reconsideration professional in order to provide verbal testimony and any additional documentation that would assist in a possible favorable determination. It is expected that the Formal Telephone Discussion Demonstration will yield the following benefits:

◾Provide an opportunity for the DME supplier community 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 decision maker prior to the reconsideration decision being made; and

◾Educate suppliers on CMS policies and requirements.

The Centers for Medicare & Medicaid Services (CMS) have determined that the Formal Telephone Discussion Demonstration will include a limited number of discussions with suppliers within Durable Medical Equipment (DME) MAC Jurisdictions C (CGS) and D (Noridian). In addition, the service types under this demonstration will initially be focused on diabetic testing supplies and oxygen equipment. The Formal Telephone Discussion Demonstration is limited to a maximum of five claims per National Provider Identifier/Supplier Identifier (NPI) in which to initiate a discussion.

If an appeal is selected for the Formal Telephone Discussion Demonstration, the QIC will notify the supplier via mail with a scheduled time and date for the formal telephone discussion to be conducted. Participation in this demonstration is voluntary. Therefore, in order to participate, the supplier will need to reply by returning the form enclosed with the election acknowledgement letter contact information form via mail or fax within the time frame indicated in the letter.

If you have questions regarding the DME Formal Telephone Discussion Demonstration, you may call us at (904) 224-7349.

C2C Innovative Solutions, Inc.

QIC DME- Formal Telephone Discussion Demonstration

P.O. Box 44044

Jacksonville, FL 32202-5103

Telephone: (904) 224-7349

Fax: (904) 224-2711