Appeals

Access information regarding your appeal rights and learn more on submitting an appeal request on the Palmetto GBA Appeals page:

  • Some denials can be adjusted via telephone reopening 
  • You may submit your appeal request in writing or through our website using eServices
  • Railroad Medicare also accepts redetermination requests via fax at (803) 462-2218
  • First level of appeal: redetermination. Timeframe: 120 days from the receipt of the initial determination. The notice of initial determination is presumed to be received five days from the date of the notice.
  • 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 the CMS 20033a form to the Part B South Qualified Independent Contractor (QIC).  Information about the QIC can be found on the C2C Innovative Solutions, Inc. website

Latest Articles

      

If my claim is denied for failure to submit requested documentation within 45 days of an Additional Documentation Request (ADR), should I submit a new claim and attach the requested documentation with the new claim? 06/03/2016
Limiting the Scope of Review on Redeterminations and Reconsiderations of Certain Claims Open in New Window05/11/2016
Limiting the Scope of Review on Redeterminations and Reconsiderations of Certain Claims MLN Matters Article - Revised 05/11/2016
Medically Unlikely Edits (MUE) 03/28/2016
Railroad Medicare Accepts Faxed Redetermination Requests 03/28/2016
Redetermination Request Form for Railroad Medicare Claims 03/28/2016
Can we submit an appeal if we disagree with an Medically Unlikely Edit (MUE) denial? 03/02/2016
General Appeals Information 10/22/2015
Notification of the 2016 Amounts in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge (ALJ) or Federal District Court Appeals 10/22/2015
Signature Requirements for Redetermination Requests: Reminder 10/12/2015
Redetermination Time Limit: Reminder 10/09/2015
Redetermination Status Tool 09/01/2015
Medicare Parts A & B Appeals Process CMS Fact Sheet Open in New Window07/14/2015
Medicare Medical Records: Signature Requirements, Acceptable and Unacceptable Practices 07/10/2015
Instead of a Written Redetermination: Consider Having Your Claim Reopened 07/01/2015
Checklist for Timely Filing Extension 03/30/2015
Prevent Duplicate Appeal Requests 03/12/2015
Redeterminations: What Information Should I Send with Faxed, Online, or Mailed Requests Submissions 11/09/2014
More Appeals Forms Now Available in eServices 05/20/2014
Railroad Medicare Accepting Appeal Requests Through Our eServices Tool 11/15/2012
   

Contact Railroad Medicare

Email Railroad Medicare

Contact a specific Railroad Medicare department

Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

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