We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.

Published Date:04/20/2016

Printed Date: 9/22/2015

URL: http://palmgba.com/marlowe/redesign6/article.html

Appeals

Submitting an appeal:

Providers are encouraged to submit their appeals via Palmetto GBA's eServices portal
By using eServices, providers can submit the appeal request and the complete medical record online

Once submitted, you will receive a confirmation from Palmetto GBA indicating that the appeal has been received

For more information please review the Appeals section in the eServices manual

You may also complete the forms electronically on our website

Please include your first and last name. You can then print the form.
Attach the complete medical record and mail to the address indicated on the form. The appeals form can be found on our website

First level of appeal: redetermination. Timeframe: 120 days from the date of the initial determination. Services that are "returned to provider" with remark code MA130 must be corrected and resubmitted, not appealed.

Second level of appeal: reconsideration. Timeframe: 180 days from receipt of redetermination. Submit this form to the Qualified Independent Contractor.

Appeal Letters

Appeal letters are sent with the results for partially paid services and denied services

Status Lookup Tools

Appeals Status Tool
Administrative Law Judge (ALJ) (Third Level) Status Lookup Tool: HHS.gov website

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Guide to Understanding the Limitation of the Scope of Review on Redeterminations and Reconsiderations of Certain Claims	01/22/2021
Maximus Federal Services, Inc. Is the Qualified Independent Contractor (QIC) for the Part A West Jurisdiction	01/22/2021
Provider Adjustments Denied for Medical Necessity or After an Appeal Has Been Submitted	01/22/2021
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Notification of the 2021 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge (ALJ) Hearing or Federal District Court Review	10/06/2020
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Appeal Levels and Timely Filing Limits: Helpful Information	03/02/2020
Fully Favorable Decisions: Part A and Part B Appeals	02/10/2020
What is My Appeal Status? Module	12/17/2019
Part A East Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration	08/29/2019
Adding Late Charges to A Claim	03/27/2019
Clarification of the First Level Appeal Decision Letter	03/27/2019
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