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