Appeal Instructions

Part D Plans - Appeal Instructions Video

• Submission Instructions Video
• Transcript (PDF)

• General Appeal Instructions
  • You may submit the appeal requests and subsequent documentation through one of the following methods:
    • QIC Appeals Portal
    • Fax
    • Mail / Courier

• Only submit one reconsideration request and one case file per submission.
• Please submit all case file documentation for the appeal at the same time in a single submission.
• Please do not submit the same request for an appeal more than once. For example, if you submit through the QIC Appeals Portal, then do not fax the same submission. Submitting the same request more than once creates duplicate appeals and may delay proper processing of your appeal.
• If you are submitting an auto-forward, you must include a fully completed Part D QIC Drug Appeal Case File Transmittal Form as the cover page of your PDF upload.
• If you are responding to a Part D QIC case file request, you must include the Part D QIC Case File Request Form as the cover page of your PDF upload, immediately followed by a fully completed Part D QIC Drug Appeal Case File Transmittal Form (PDF) or the Part D QIC LEP Appeal Case File Transmittal Form (PDF), then followed by a Part D Drug Appeal Case File Narrative Form (PDF) or the Part D QIC LEP Appeal Case File Narrative Form (PDF).
  • Case File must be submitted in this order:
    • ‘Case File Request Form’
    • ‘Case File Transmittal Form’
    • ‘Case File Narrative Form’
    • Case file documents (EOCs, Formularies, Prior Authorization, Prescriber Statements, Medical Records, LEP notification letter, etc.).
• If you are submitting follow-up or subsequent documents for a case file you have already submitted, you must include a cover page that identifies the MAS Appeal Number, enrollee initials and MBI, Appeal Type (Expedited, Standard or LEP), the nature of your submission. We strongly recommend you use the Part D QIC Case File Follow Up / Additional Documentation Form (PDF). Proper identifiers are required to ensure your submission is indexed to the case.

• The Part D QIC receives the reopening request in writing via email to the Plan Liaison at: QPD-Plan_Liaison@c2cinc.com
  • In the email subject line include “Reopening Request” and the appeal number
  • The reopening request and reasoning should be clearly stated in the body of the email
  • The reopening request must be made within CMS timeframes permitted for re-opening
  • The Reopening Adjudicator reviews the reopening request and determines whether to grant reopening based on a good cause analysis in accordance with § 423.1986. The Part D QIC notifies the reopening requestor of its decision whether or not to grant reopening within 30 calendar days of the receipt of the reopening request

• QIC Appeals Portal Instructions
  • QIC Appeals Portal User Guide (PDF)
  • The QIC Appeals Portal has the capacity to accept 1500-2000 pages in a single upload. Please contact the Plan Liaison if you are having difficulty submitting in a single upload.
  • The QIC Appeals Portal permits users to identify a brief nickname (6 characters) for the submission. We recommend you identify your submission using the last 6 numbers of the MAS QIC number.