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The Request Copy of Decision Letter feature allows you to submit an anonymous request to the Part A West, Part B DME, and Part C Medicare Managed Care QIC.   When this request is submitted you will not receive a response via this website.   The request will be received by the QIC team and a response will be sent via mail.  The fields available for you to complete on the Request Copy of Decision Letter page are as follows:

Appeal Number:  There are two options for the Appeal Number field.  1) Provide the Appeal Number that is referenced on the Acknowledgement Letter you received for the appeal in question. This number will always start with 1-.   2)  If you submitted the Appeal Request via the QIC Portal you can provide the Portal/Temp ID that you were provided at the time of the Appeal submission.  This number will always start with Q22-, or Q21-

 

Party Type:  This field will be used to identify who we need to send a copy of the Decision Letter to.   We cannot collect any details about names or addresses on this site so as to protect you privacy.  The option you select for this field will be sufficient to identify those details when we receive your request.