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Care Improvement Plus
National Home › Providers › Provider Documents › Non-Par Provider Payment

Non-Par Provider Payment

The section only applies to providers that provide services to Care Improvement Plus members, but do not hold a contract with the Health Plan (non-par).

Non-Par Provider Payment Dispute Procedures

Non-Par provider payment disputes apply to any claim that is paid at a rate less than original Medicare or the provider disagrees with the Plan’s decision to pay for a different service than that billed, or down-coding. Provider payment disputes exclude payment denials by an organization that result in zero payment.

A provider is considered non-par until the credentialing process is complete.

The Health Plan has 30 days to resolve a payment dispute. The non-par provider may contact the Plan to register a payment dispute by calling the Provider Services line at: 1-866-679-3119 (please indicate to the provider service rep that this qualifies as a non-par provider payment dispute) or mail your payment dispute to:

Care Improvement Plus
351 W. Camden Street, Suite 100
Baltimore, MD 21201
Attention: Non-Par Provider Payment Disputes

Non-Par Provider Rights:

  • The non-par provider has the right to request an independent decision when:
    – Amount paid is less than original Medicare
    – Disagrees about the Plan’s decision to pay for a different service than that billed (down-coding)
    – Plan fails to make a decision in response to a dispute within 30 days from the date the dispute was received by the Plan
    • Provider may request a Payment Dispute Decision (PDD)
    • Must provide evidence to FCSO when filed with Plan
  • Excludes payment denials by organizations that result in zero payment
    – Must process as appeal

Filing for a Payment Dispute Decision

CMS’ Payment Dispute Resolution Contractor:

CMS' Payment Dispute Resolution Contractor:
C2C Solutions, Inc.

  • Website: http://www.c2cinc.com
  • Email (No PHI): PDRC@C2Cinc.com
  • Fax: 904-361-0551
  • Call Center: 904-791-6430
    – Can leave message; return call within 2 day
  • Mail initial disputes to:
    C2C Solutions, Inc.
    Payment Dispute Resolution Contractor
    P.O. Box 44017
    Jacksonville, FL 32231-4017
  • Mail follow-up hard copy correspondence associated with dispute request to:
    C2C Solutions, Inc.
    Payment Dispute Resolution Contractor
    P.O. Box 44035
    Jacksonville, FL 32231-4035

Include the following information with the initial dispute submission:

  • Provider contact information, including name & address
  • Pricing information, including NPI (& CNN/OSCAR # for institutional providers), zip code where services rendered, physician specialty
  • Organization &/or Plan name that made redetermination
  • Attestation that the provider is a non-contracted provider
  • Reason for dispute & description of the specific issue
  • Copy of provider’s claim as submitted to Plan for payment with disputed portion identified
  • Copy of Plan’s original pricing determination (Remittance)
  • Copy of Plan’s unfavorable redetermination or, if available, evidence that the Plan did not respond to dispute in 30 days
  • Any documentation or correspondence that supports the provider’s position that the Plan’s reimbursement is not correct
  • Appointment of Provider Representative Authorization Statement, if applicable
  • Name & signature of the provider or provider representative



This page was last updated on: 6/2/2011 10:59:27 AM
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Copyright © 2006 - 2012 Care Improvement Plus
Y0072_OE12_4511 CMS Approved 11/15/2011

Care Improvement Plus is a Medicare Advantage organization with a Medicare contract. The Care Improvement Plus contract with CMS is renewed annually and coverage availability beyond the end of the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013.

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. For more information contact the plan. To be eligible for a Care Improvement Plus plan you must be a Medicare beneficiary living in Arkansas, Georgia, Missouri, South Carolina, Texas and select counties in Illinois, Iowa, Indiana, Maryland, New Mexico, New York, Wisconsin and have both Medicare Part A and Part B to enroll.

To be eligible for a Care Improvement Plus Chronic Conditions Special Needs Plan, you must have diabetes and/or heart failure. To be eligible for Care Improvement Plus Dual Advantage, you must be enrolled in state Medicaid and be a dual eligible beneficiary whom the State holds harmless for Part A and Part B cost sharing.

Members may enroll in the plan only during specific times of the year. Contact Care Improvement Plus for more information. If you have diabetes, heart failure, or Medicaid/Low Income Subsidy, you may qualify to enroll in a Care Improvement Plus Special Needs Plan ANYTIME of the year by exercising a “Special Election Period.

You must continue to pay your Medicare Part B premium. If you are a full benefit dual beneficiary and your Part B premium is paid for by the State, you will not be responsible for paying your Part B premium. Premiums, copays, coinsurance and deductibles may vary based on the level of help received. Limitations, copayments and restrictions may apply.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1–800–MEDICARE (1–800–633–4227). TTY users should call 1–877–486–2048, 24 hours a day/7 days a week;
  • The Social Security Office at 1–800–772–1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1–800–325–0778; or
  • Your State Medicaid Office.

People with limited incomes may qualify for extra help to pay their prescription drug costs. If eligible, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office, or call Social Security at 1–800–772–1213.TTY users should call 1–800–325–0778. You can also apply for extra help online at www.socialsecurity.gov/prescriptionhelp. If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a part of this premium, we will bill you for the amount that Medicare doesn’t cover.

Premiums, copays, coinsurance, and deductibles may vary based on the level of help that beneficiaries may receive. Contact the plan for further details. Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under nonroutine circumstances, and quantity and restrictions may apply. It may cost more to get care from out–of–network providers, except in an emergency. If there isn’t a network provider available for you to see, you can go to an out–of–network provider but still pay the in–network amounts except for members who live in our Maryland service areas. Those members can only use doctors, specialists, or hospitals in–network. The health providers in our network can change at any time.