Appeals

Claims can be denied for a variety of reasons. Find out how you can file an appeal if you feel a claim was denied incorrectly.


Submitting an Appeal

  • Avoid future appeals by using the Denial Resolution tool
  • Submit first level appeal and reopening requests using the Secure Forms function of the free eServices portal
  • For eDelivery of appeal letters, sign up for the eServices Portal
  • Some denials caused by clerical errors can be corrected via telephone reopening; please call 877–567–7271
  • Appeals forms: Complete the forms electronically then print the forms, attach supporting documentation, and then mail to the address on the form
  • First level of appeal: redetermination. Time frame: 120 days from the date of the initial determination. Services that are "rejected as unprocessable" with remark code MA130 must be corrected and resubmitted, not appealed.
  • Second level of appeal: reconsideration. Second level of appeal: reconsideration. Time frame for submitting a reconsideration request is 180 days from the date of receipt of the redetermination decision. Submit your reconsideration request directly to the Qualified Independent Contractor (QIC). The address is located on the reconsideration request form and can also be found within the redetermination decision letter.

Fax number for Part B redetermination requests: (803) 870–0139

You may also mail redetermination requests to:

Palmetto GBA - JJ Part B - AG-655
P.O. Box 100306
Columbia, SC 29202–3306

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Appeals Articles