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

      

Appeals Forms Available in eServices 11/07/2016
Railroad Medicare Accepts Appeal Requests Through Our eServices Tool 11/04/2016
General Appeals Information 10/19/2016
Notification of the 2017 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge (ALJ) Hearing or Federal District Court Review 10/19/2016
Can we submit an appeal if we disagree with an Medically Unlikely Edit (MUE) denial? 09/01/2016
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? 09/01/2016
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
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
   

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

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bid Program

JM Part A

JM Part B

JM Home Health & Hospice

MolDX

Railroad Medicare Providers

Railroad Medicare Beneficiaries

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