Selected Dispute Resolution Entity
C2C Innovative Solutions, Inc. (C2C) is the Selected Dispute Resolution Entity (SDRE) contracted by CMS to conduct the Patient-Provider Dispute Resolution (PPDR) process. The SDRE is an independent entity that has been certified by CMS to review disputes between patients and providers and to make impartial payment determinations.
On Oct. 7, 2021, the United States Department of Health and Human Services (HHS) published in the Federal Register interim final rules (IFRs) titled Requirements Related to Surprise Billing; Part II, implementing various provisions of the No Surprises Act (NSA), including good faith estimates and the PPDR process for payment determinations.
An uninsured (or self-pay) individual (or their authorized representative) may initiate the PPDR process by submitting a Patient-Provider Dispute Resolution Form through the Federal Independent Dispute Resolution (IDR) portal, email or postal mail to HHS. You must submit your dispute within 120 calendar days of the date on the initial bill containing the charge for the item or service that is “substantially in excess” of the amount listed on the Good Faith Estimate (GFE). This means that the billed charges for the items or services are at least $400 more than the estimated charge shown on the GFE.
A non-refundable administrative fee of $25 is required to process a dispute. As the SDRE, C2C must receive payment of the administrative fee before it can review your dispute. You may pay the $25 administrative fee electronically by debit/credit card. (PayPal, Venmo and Cash App payment options will be available soon.) If you prefer other forms of payment, you may pay by cashier’s check or money order. Personal checks and cash are not accepted. (Please see the Payments page for additional information and links to the electronic payment methods.)
To submit your Patient-Provider Dispute Resolution Form, please use the Federal IDR portal at https://www.cms.gov/nosurprises/consumers.
If you don’t have the ability to submit your dispute through the Federal IDR portal, print and securely fax or mail your completed form to:
C2C Innovative Solutions, Inc.
Patient-Provider Dispute Resolution
P.O. Box 45105
Jacksonville, FL 32232-5105
Fax Number: 1-888-610-4092
For additional information about the PPDR process, please visit: https://www.cms.gov/nosurprises