The non-refundable administrative fee is due within 10 business days from the date of the notice acknowledging receipt of your request for a dispute resolution. The SDRE, C2C Innovative Solutions, Inc., will not be able to begin the dispute resolution process until it receives payment of the administrative fee.
To submit your payment for the Patient-Provider Dispute Resolution administrative fee electronically, please click the "Pay with credit/debit card" icon below. (PayPal, Venmo and Cash App payment options will be available soon.) Prior to selecting, make sure you have your dispute reference number readily available. Your dispute reference number can be found on the notice acknowledging receipt of your request for a dispute resolution. You will not be able to submit your payment electronically if you do not have the dispute reference number.
Click to pay with credit or debit card:
Cashier’s Checks or Money Orders:
Personal checks or cash will not be accepted. To submit your payment for the Patient-Provider Dispute Resolution administrative fee using a cashier’s check or money order, please include your dispute reference number on the cashier’s check or money order. If you do not have your dispute reference number, please include the National Provider Identifier (NPI) of the provider whose bill you are disputing, along with the patient’s name. The provider’s NPI number is located on the Good Faith Estimate that you should have received. The dispute reference number or NPI and the patient’s name are critical to ensure your payment is posted timely to the correct dispute resolution case.
Mail your cashier’s check or money order to:
C2C Innovative Solutions, Inc.
Patient-Provider Dispute Resolution
P.O. Box 45105
Jacksonville, FL 32232-5105