Submitting an appeal:

  • Avoid future appeals by using the Denial Resolution tool
  • Submit first level appeal and reopening request using the Secure Forms function of the free eServices portal
  • For eDelivery of appeal letters, sign up for eServices today
  • Some denials can be adjusted via telephone reopening; please call 855–696–0705
  • Appeals forms: complete the forms electronically then print the forms, attach supporting documentation, and then mail to the address on the form
  • First level of appeal: redetermination. Time frame: 120 days from the date of the initial determination. Services that are "rejected as unprocessable" with remark code MA130 must be corrected and resubmitted, not appealed.
  • Second level of appeal: reconsideration. Time frame: 180 days from receipt of redetermination. Submit this form to the Qualified Independent Contractor (address is located on form).

Fax number for Part B redetermination requests: (803) 699–2427

You may also mail redetermination requests to:

Palmetto GBA Part B – AG-655
P.O. Box 100190
Columbia, SC 29202–3190

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Contact Palmetto GBA JM Part B Medicare

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Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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