C2C Innovative Solutions, Inc. fax number

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

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

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.