Appeals

Submitting an Appeal

• Providers are encouraged to submit their appeals via Palmetto GBA's eServices portal
• By using eServices, providers can submit the appeal request and the complete medical record online
• Once submitted, you will receive a confirmation from Palmetto GBA indicating that the appeal has been received
  • When attempting to retrieve letters from eServices, be sure to use capital letters in the claim number
  • Do not have spaces before or after the claim number
  • Do not use special characters
• For more information please review the Appeals section in the eServices manual
• You may also complete the forms electronically on our website
  • Please include your first and last name. You can then print the form.
  • Attach the complete medical record and mail to the address indicated on the form. The appeals form can be found on our website.
• First level of appeal: redetermination. Timeframe: 120 days from the date of the initial determination. Services that are "returned to provider" with remark code MA130 must be corrected and resubmitted, not appealed.
• Second level of appeal: reconsideration. Timeframe: 180 days from receipt of redetermination. Submit this form to the Qualified Independent Contractor.

Appeal Letters

• Appeal letters, also known as Medicare Redetermination Notices (MRNs), are sent with the results for partially paid services and denied services

Status Lookup Tools

• Appeals Status Tool
• Administrative Law Judge (ALJ) (Third Level) Status Lookup Tool: HHS.gov website