PDR Contractor—Medicare Advantage
The Centers for Medicare & Medicaid Services (CMS) has selected First Coast Service Options Inc. (FCSO) as the national independent review entity to resolve payment disputes between Medicare Advantage (MA) organizations offering Private Fee-for-Service (PFFS) plans and deemed and non-contracted providers. FCSO began accepting these disputed payment cases on Jan. 1, 2009. FCSO brings vast experience in adjudicating Medicare appeals on behalf of CMS.
Beneficiary and provider appeals of coverage determination and medical necessity will continue to be handled by the Part C IRE and will not be handled under this contract.
To file a request for an independent Payment Dispute Decision (PDD), please use the PDD Request Form. For further guidance in completion of this form, please reference these PDD Form instructions.