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Railroad Medicare
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 Online Provider Services (OPS)
  • 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 5 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 this form to the Qualified Independent Contractor (address is located on form).

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Calendar Year 2013 Update: Amount in Controversy Requirements for Administrative Law Judge (ALJ) and Federal District Court Appeals05/10/2013
General Appeals Information05/10/2013
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?03/21/2013
Reconsiderations: The Second Level of Appeal02/04/2013
Instead of a Written Redetermination: Consider Having Your Claim Reopened01/24/2013
Railroad Medicare Accepting Appeal Requests Through Our Online Provider Services (OPS) Tool11/15/2012
Medically Unlikely Edits (MUE)11/09/2012
Railroad Medicare Accepts Faxed Redetermination Requests11/09/2012
Redetermination Request Form for Medicare Railroad Claims11/09/2012
Redetermination Time Limit: Reminder11/09/2012
Redeterminations: What Information Should I Send with Faxed, Online, or Mailed Requests Submissions11/09/2012
Redetermination Status Tool Now Available Online03/20/2012
2nd Level Appeals: Qualified Independent Contractor (QIC) For Reconsiderations01/03/2012

 

last updated on 5/01/2013
ver 1.0.37