Duplicate Appeal Requests

WPS Medicare has seen a large increase in the number of duplicate appeal (redetermination) requests received from providers. The duplicate appeal requests are for the same provider, same patient, same date of service, same issue, etc. Please be aware that in accordance with CMS guidelines, in the Internet-Only Manual (IOM), Publication 100-04, Chapter 29Adobe Portable Document Format, Medicare contractors have up to 60 days to render a decision for an appeal request. Please do not submit an additional appeal request within this 60-day period, as this represents unnecessary costs and duplicative efforts to both the Medicare program and the provider's office.

In addition, Medicare can only conduct one appeal for a service rendered. If we have already issued an appeal decision, and you disagree with the appeal decision, you must proceed to the next level of appeal. The next level of appeal is a reconsideration request. Reconsideration requests are processed by the Qualified Independent Contractor (QIC), C2C Solutions, Inc. Providers should mail their reconsideration requests to the following address:

C2C Solutions, Inc.
QIC Part B North Reconsiderations
P.O. Box 45208
Jacksonville, FL 32232-5208

Page Last Updated: Friday, 03-Feb-2012 12:13:38 CST