The pay-to address is the same as where paper remittances and paper checks would be mailed to.
Please access PECOS or the CMS-855 application form that was approved by Medicare to verify your provider’s pay-to address:
- In PECOS it is located on the Physical Location and “Special Payments” Address Information topic on the right side of the physical location address area.
- On the CMS-855A & CMS-855B, it is located in section 4B.
- On the CMS-855I, it is located in section 4C.
The 13-digit ICN identifies the processed claim.
- The first two digits of the ICN that appear on remittance advice identify the type of claim or claim adjustment.
- The next two digits of the ICN identify the two-digit year the claim was received, or the adjustment was initiated.
- The remaining digits are a sequential number, assigned to each claim on the Julian date, in numeric order.
The receipt date is referenced within the Internal Claim Number (ICN) as the following:
- The third, fourth, fifth, sixth and seventh digit of the claim number is the date the claim was received. Third and fourth digit are the year and fifth, sixth, and seventh are the day. For example: ICN 0922025236000
- 22 = year
- 025 = day (the 25th day of the year)
- Claim receipt day –1/25/2022
The denial date is the same as the paid date referenced at the top of the associated remit.
We have a full list of P.O. Box Mailing Addresses available specific to your jurisdiction and type of claim submission in the Contact Us section of Resources.
Providers must file claims within one calendar year from the date of service. There are limited exceptions to this rule. View Requesting an Exception to Timely Filing for exceptions.
The Payer ID varies depending on the jurisdiction associated with the claim:
Jurisdiction K
- CT – 13102
- MA – 14212
- ME – 14112
- NH – 14312
- NY Downstate Counties – 13202
- NY Queens County – 13292
- NY Upstate Counties – 13282
- RI – 14412
- VT – 14512
Jurisdiction 6
- IL – 06102
- MN – 06202
- WI – 06302
All forms, including Appeals, are located in the Resources section of our website.
The time limit for filing a redetermination is 120 days from date of receipt of the initial determination notice. For additional information, view the full list of timely filing for each at Levels of Appeals and Time Limits for Filing.
The time limit for filing a reconsideration is a 180 days from date of receipt of the redetermination decision. For additional information, view the full list of timely filing for each Levels of Appeals and Time Limits for Filing.
In order to submit your reconsideration in writing you will need to complete the CMS-20033 Medicare Reconsideration Request Form or the reconsideration request form included with the redetermination decision. Send the completed CMS-20033 Medicare Reconsideration Request Form to the QIC appeals mailing address:
C2C Innovative Solutions, Inc.- QIC Part B North
P.O. Box 45208
Jacksonville, FL 32232-5028
CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34 – Reopening and Revision of Claim Determinations and Decisions, Section 10.6.2 offers the following protocol for filing an appeal.
A party may request a contractor reopen and revise its initial determination or redetermination under the following conditions:
- Within one year from the date of the initial determination or redetermination for any reason; or
- Within four years from the date of the initial determination or redetermination for good cause as defined in Section 10.11; or,
- At any time if the initial determination is unfavorable, in whole or in part, to the party thereto, but only for the purpose of correcting a clerical error on which that determination was based.
Third party payer error does not constitute clerical error as defined in Section 10.4.
Related Content
The reopening form is located on the Forms page of our website. Be sure to send the form to the correct P.O. Box based on the jurisdiction.
There is no Medicare benefit for a sign language interpreter; however, the issue may be addressed at the State level. Please note:
- Per the Affordable Care Act of 2010: Section 1557, discrimination on the base of disability is prohibited
- Per Title II of the Americans with Disabilities Act, health care providers have a duty to provide communication using auxiliary aids and services that will assist persons with hearing loss. Examples include: qualified interpreters, decoders, and telecommunication devices.