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Jurisdiction 11 Part B
Appeals

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

  • Avoid future appeals by submitting claims accurately: use the Denial Resolution tool
  • Some denials can be adjusted via telephone reopening, please call 855-696-0705
  • 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 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, and not appealed.
  • Second level of appeal: reconsideration. Time frame: 180 days from receipt of Redetermination (see above). Submit this form to the Qualified Independent Contractor (address is located on form).

Fax number for J11 Part B redetermination requests: (803) 699-2427

You may also mail redetermination requests to:
Palmetto GBA Part B – J11 MAC, AG-655
P.O. Box 100190
Columbia, SC 29202-3190



Search this Area Search this Area
More Appeals Forms Now Available in Online Provider Services (OPS)05/20/2014
New OPS Forms for Requesting a Reopening or Redetermination05/13/2014
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 for Cancelled Claims Related to Medicare Beneficiaries Classified as 'Unlawfully Present' in the U.S.04/03/2014
Second Level of Appeal: Reconsideration Request Form04/01/2014
Instead of a Written Redetermination: Consider Having Your Claim Reopened03/20/2014
Reconsideration: Second Level Appeal Reminders02/28/2014
Prevent Duplicate Appeal Requests02/15/2014
General Appeals Information12/11/2013
Calendar Year 2014 Update: Amount in Controversy Requirements for Administrative Law Judge (ALJ) and Federal District Court Appeals12/02/2013
Avoid Processing Delays and Send the Overpayment Demand Letter With Your Appeal Request12/01/2013
Redetermination Time Limit: Reminder10/09/2013
Telephone Reopening Tips10/01/2013
Redetermination Status Tool Available Online08/15/2013
When to Request a Redetermination or a Reopening: Reminder06/19/2013
Hints for Submitting Medical ADR (Additional Documentation Requests) or Appeal Requests05/15/2013
J11 Part B Redetermination Requests01/09/2013
Prevent Duplicate Appeal Requests05/03/2012
Appeal Rights: Know the Rules03/08/2012
Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Appeals via Facsimile and/or via a Secure Internet Portal/Application03/01/2011

 

last updated on 9/01/2014
ver 1.0.51