Appeals

• 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
  • You must then print and sign the forms. Please print your first and last name and then sign.
  • Once signed, attach the complete medical record and mail to the address indicated on the form. The appeals form can be found on our website.   
  • Or, you have the option to submit requests for a redetermination and the medical record via fax at (803) 699–2425
• 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 (address is located on form).

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