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, also known as Medicare Redetermination Notices (MRNs), are sent with the results for partially paid services and denied services

Status Lookup Tools

Latest Articles

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C2C Innovative Solutions, Inc Quarterly Newsletter Released 10/19/2020
General Appeals Information 10/06/2020
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
Medicare Redetermination Notices Mailing Address 09/14/2020
Can I Appeal My Claim Denial? Module Open in New Window07/17/2020
Medicare Parts A and B Appeals Process CMS Fact Sheet Open in New Window06/19/2020
eServices Appeals Feature 06/08/2020
Appeals and Clerical Error Reopenings Module Open in New Window05/15/2020
Appealing an Overpayment Subject to Limitation on Recoupment 04/02/2020
Appeals Timeliness Calculator Open in New Window03/09/2020
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 Open in New Window12/17/2019
Part A East Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration 08/29/2019
Redetermination: First Level Appeal Form 07/05/2019
Submit Appeals via Palmetto GBA's eServices Portal 07/05/2019
Adding Late Charges to A Claim 03/27/2019
C2C Innovative Solutions, Inc.: Qualified Independent Contractor (QIC) for Part A East Jurisdictions 03/27/2019
Clarification of the First Level Appeal Decision Letter 03/27/2019
Fax Number for Submitting Redeterminations 03/27/2019
Guide to Understanding the Limitation of the Scope of Review on Redeterminations and Reconsiderations of Certain Claims 03/27/2019
How to Use Modifiers to Indicate the Status of an Advanced Beneficiary Notice (ABN) 03/27/2019
Outpatient Prospective Payment System (OPPS) - Redetermination Requests for Drugs Acquired under 340B Program 03/27/2019
Please Use the Correct File Format when Mailing Appeal Requests/Redeterminations and Medical Records 03/27/2019
Provider Adjustments Denied for Medical Necessity or After an Appeal Has Been Submitted 03/27/2019
Appeals Status Tool Open in New Window03/25/2019
   

Contact Palmetto GBA JJ Part A Medicare

Provider Contact Center: 877-567-7271

Email JJ Part A

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