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CCME: Medicare Quality of Care Complaint

To submit your quality of care complaint to CCME, please include the following information when requesting review of a Medicare patient’s medical records:

  • Medicare patient’s name and Medicare number.
  • Medicare patient’s complete address and phone number (including area code).
  • Type of services rendered.
  • Name and address (including city) of the facility where care was given.
  • Date(s) care was received.
  • Description of the quality of care concern.
  • If you are enrolled in a Medicare Advantage Organization, please include the organization’s name and address.

Send North Carolina quality of care review request to:
The Carolinas Center for Medical Excellence
Attn: Intake Coordinator
100 Regency Forest Drive, Suite 100
Cary, North Carolina  27518

Send South Carolina quality of care review request to:
The Carolinas Center for Medical Excellence
Attn: Intake Coordinator
246 Stoneridge Drive, Suite 200
Columbia, South Carolina  29210

Form

CCME Medicare Resource  Medicare Quality of Care Complaint Form (62.8 KB)  
Please complete this form electronically, print out, and mail the signed form to CCME. DO NOT email or fax this form.
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