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PACE Appendix

The PACE Appendix contains instructions and forms for PACE organizations to use when communicating with C2C about reconsideration appeals and related activities.

Individual Forms

Appointment of Representative Statement
Key PACE Organizational Contact Form
New Case File Transmittal Cover Sheets for PACE Participant Reconsideration Requests to the IRE
PACE Organization Reopening Request Form
PACE Organization Response to IRE Request for Additional Documentation Transmittal Cover Sheet
PACE Organization Submission of Additional Information Authorizing Coverage or Payment for an Item, Service, or Part B Drug Subsequent to the PACE Organization Submission of the Case and Case File to the IRE for Processing of the IRE Reconsideration
PACE Reconsideration Background Data Form
Statement of Compliance Form-IRE Reconsideration Decision