Enrollees and Representatives
The Part C Qualified Independent Contractor (QIC) is responsible for receiving and conducting new reconsiderations of adverse organization determinations and adverse reconsiderations made by Medicare Advantage (MA) Organizations, Medicare Cost Plans, Health Care Prepayment Plans (HCPPs) and Program of All-Inclusive Care for the Elderly (PACE) Organizations, in addition to any CMS-approved Medicare managed care demonstrations.
Medicare Advantage plans are managed care plans that contract with Medicare to offer all Medicare-covered services, as well as additional services outside of traditional Medicare (e.g., vision coverage, prescription drug coverage). Medicare Advantage plans are required to follow all Medicare laws and coverage policies, including Local Coverage Decisions (i.e., coverage policies set by Medicare Fee-for-Service contractors in your geographic area) when determining coverage for a particular service.
PACE Organizations are unique managed care programs that provide virtually all medical and social services for participating frail elderly. PACE Organizations are typically not-for-profit or public entities. PACE Organizations use a multidisciplinary team approach in an adult day health center supplemented by in-home and referral services in accordance with the participant's needs. PACE Organizations provide more comprehensive coverage than traditional Medicare or Medicare managed care.
The menu contains links to useful information for Medicare managed care enrollees and representatives.
How to Request Review of Plan Dismissal
- This provides instructions on how to appeal the Plan Dismissal if you disagree with it.
Medicare Appeals and Your Rights
- This provides general information about the Medicare managed care appeals process.
Who Can Help You with Your Appeal
- This provides information about persons or organizations that can help with your Medicare appeal.
Search Appeals Status
- This provides a searchable database of reconsideration appeals.
Obtain a Copy of Your Case File
- This provides instructions on how you can request a copy of your reconsideration case file.
How to Request an ALJ Hearing
- This provides instructions on how to appeal the C2C decision if you disagree with it.
CMS Medicare Parts C IRE Decision Database
- This provides summaries of QIC decisions on Medicare Part C appeals.
Enrollee and Representatives QIC Contact Sheet
- This provides contact information for communication with C2C.
For general information about Medicare managed care, refer to our Laws and Regulations webpage.