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 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
Administrative Law Judge (ALJ) (3rd Level) Status Lookup Tool: HHS.gov website