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Auxilary Aids & Services

For information about the availability of auxiliary aids and services, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html

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Jurisdiction 11 Home Health and Hospice
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) 699-2425
  • 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 (address is located on form).

Appeal Letters

  • Appeal letters with the results are sent for partially paid services and denied services
  • Effective July 1, 2013, appeal letters will also be sent for services that are paid in full


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Hints for Submitting Medical ADR (Additional Documentation Requests) or Appeal Requests10/28/2014
Calendar Year 2015 Update: Amount in Controversy Requirements for Administrative Law Judge (ALJ) and Federal District Court Appeals10/20/2014
General Appeals Information10/20/2014
Automation of the Request for Reopening Claims ProcessOpen in New Window09/09/2014
Scenarios and Coding Instructions for Submitting Requests to Reopen Claims that are Beyond the Claim Filing Timeframes - Companion Information to MM8581: 'Automation of the Request for Reopening Claims Process'Open in New Window09/09/2014
Chapter 29 Appeals Update (Includes Post-DOMA Guidance and Signature Requirement for Appointment of Representatives and Assignment of Appeal Rights)Open in New Window04/18/2014
Appeals, Adjustments and the D9 Claim Change Reason (Condition) Code and Cancelling a Claim03/27/2014
Submit Appeals via Palmetto GBAs Online Provider Services (OPS) Portal03/24/2014
Fax Number for Submitting Redeterminations02/05/2014
What is the Status of My Appeal?09/11/2013
Providers Cannot Make an Adjustment to a Claim Once it has Been Through the Redetermination Process06/06/2013
MAXIMUS Federal Services: Qualified Independent Contractor (QIC) for Part A East and West Jurisdictions05/20/2013
Redetermination Dismissals Job Aid09/04/2012
Clarification of the First Level Appeal Decision Letter05/30/2012
Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Appeals via Facsimile and/or via a Secure Internet Portal/Application06/16/2010
Change in the Amount in Controversy Requirement for Administrative Law Judge Hearings and Federal District Court Appeals05/12/2010
Reminder When Submitting a Request for a Redetermination12/18/2007

 

last updated on 10/01/2014
ver 1.0.51