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C2C Innovative Solutions, Inc. fax number
(904) 539-4075
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Part C QIC (Medicare Part C) Appeals
Used for: Submission of Part C Medicare Plan reconsiderations/appeals (Expedited, Standard Part B Drug, and Other Appeals) to the QIC Part C; documentation may be uploaded via the secure portal or faxed to specified numbers.
Fax destination details
- Department
- Part C QIC (Medicare Part C) Appeals
- Purpose
- Submission of Part C Medicare Plan reconsiderations/appeals (Expedited, Standard Part B Drug, and Other Appeals) to the QIC Part C; documentation may be uploaded via the secure portal or faxed to specified numbers.
- Form
- Plan Authorization of Coverage or Payment Request Form (Part C) — Plan Authorization of Coverage or Payment Request Form
- Address
- 301 W. Bay St., Suite 1110, Jacksonville, FL 32202
- Voice phone
- 1-866-439-0863
- Website
- Visit organization website
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Submit the Plan Authorization of Coverage or Payment Request Form (Part C) via the secure portal or by fax to 904-539-4075 (Expedited), 904-539-4076 (Standard Part B Drug), or 904-539-4078 (Any Other Appeal). Include relevant case details and documentation.
Official form instructions are published as a downloadable file on the organization's website.
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