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Jurisdiction 1 Part A
Appeals

Access information regarding your appeal rights on the Palmetto GBA Appeals page:

  • Appeals forms are located on this page. You may complete the forms electronically then print and sign the forms, attach supporting documentation and mail to the address indicated on the forms.
    • Or you have the option to submit requests for a redetermination and supporting documentation via fax at (803) 462-3913
  • First level of appeal: redetermination. Time frame: 120 days from the date of the initial determination. Services that are ‘returned to provider’ with remark code MA130 must be corrected and resubmitted, and not appealed.
  • Second level of appeal: reconsideration. Time frame: 180 days from receipt of redetermination. Submit this form to the Qualified Independent Contractor (address is located on form).

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MAXIMUS Federal Services: Qualified Independent Contractor (QIC) for Part A East and West Jurisdictions05/20/2013
Calendar Year 2013 Update: Amount in Controversy Requirements for Administrative Law Judge (ALJ) and Federal District Court Appeals05/10/2013
General Appeals Information05/10/2013
Administrative Law Judge (ALJ) Decisions: Impact on Some Inpatient Medicare Claims11/16/2012
What is the Status of My Appeal?10/02/2012
Redeterminations: What information should I send with the request?09/21/2011
First Level Appeal Request - J1 Part A Redetermination Request Form01/29/2009

 

last updated on 5/01/2013
ver 1.0.37