Health Plans
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. These 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 Part C Health Plans and PACE Organizations.
Medicare Part C Health Plan QIC Contact Sheet
- This provides contact information for health plan communication with C2C.
Medicare Advantage Process Manual
- This manual contains the procedures for the coordination of Medicare Health Plans with C2C in the processing of IRE level reconsiderations and related post-reconsideration activities.
Medicare Advantage Appendix
- This appendix provides health plans with forms and instructions for reconsideration background data and case narrative.
PACE Organization QIC Contact Sheet
- This provides contact information for PACE Organization communication with C2C.
PACE Process Manual
- This manual contains the procedures for the coordination of PACE Organizations with C2C in the processing of IRE-level reconsiderations and related post-reconsideration activities.
PACE Appendix
- This appendix provides PACE Organizations with forms and instructions for reconsideration background data and case narrative.
Key Contact Form
- This form gathers key contact information from health plans, which C2C will use to communicate important updates and escalate issues.
Search Effectuation Data
- This page provides a searchable database of effectuation data on appeals.
Search Appeal Status
- This page provides a searchable database of reconsideration appeals.
QIC IRE Part C Appeals Portal
- This page allows health plans to submit appeals and respond to requests from C2C through a secure online portal.
QIC IRE Part C Appeals Portal User Guide
- This document provides Health Plans with a user guide for the QIC IRE Part C Appeals Portal.
For general information about Medicare Managed Care, refer to our Laws and Regulations page.
For C2C’s Part C Newsletter, refer to our Newsletter page.