Access information regarding your appeal rights on the Palmetto GBA Appeals page:
- Avoid future appeals by submitting claims accurately: use the Denial Finder tool
- Some denials can be adjusted via telephone reopening
- 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.
- First level of appeal: redetermination. Timeframe: 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. Timeframe: 180 days from receipt of Redetermination (see above). Submit this form to the Qualified Independent Contractor (address is located on form).