Get C2c Solutions Provider Inquiry Form - Connect

The C2C Solutions Provider Inquiry Form is essential for reporting issues related to documentation oversight or incorrect appeal processing. This guide provides comprehensive instructions to ensure accurate completion of the form.

Follow the steps to successfully complete the inquiry form.

1. Click ‘Get Form’ button to obtain the form and open it in the appropriate interface.
2. Begin by entering the C2C appeal number at the designated field. This number is critical for tracking your inquiry.
3. Next, input the C2C appeal decision. Provide the specific outcome that was communicated to you regarding your appeal.
4. In the 'Provider’s complaint regarding this denial' section, clearly articulate your concerns. Include any relevant CMS published references or specify the name and paragraph of documentation that supports your claim.
5. Fill in your provider name and address accurately to avoid any miscommunication.
6. Provide the contact name as well as a valid contact phone number to facilitate further communication regarding your inquiry.
7. Once all applicable fields are completed, take a moment to review your entries for accuracy and completeness. This will help ensure a smooth processing of your inquiry.
8. After finalizing the form, save your changes. You will have options to download, print, or share the completed form as necessary.

Complete your inquiry form online today for efficient resolution!