Appeals

Published 12/01/2016

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

  • 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
    • 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

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