Palmetto GBA

LICENSE FOR USE OF "Physicians' CURRENT PROCEDURAL TERMINOLOGY",
FOURTH EDITION ("CPT")

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Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. You should contact Paul A. Markowski at the American Medical Association, CPT Intellectual Property Services, American Medical Association, 515 N. State Street, Chicago, Illinois 60610 or at telephone number 312-464-5943 or at facsimile number 312-464-5762, should you wish to make additional uses of CPT.

Applicable FARS/DFARS Restrictions Apply to Government Use. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)(June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14(June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14(June 1987) and FAR 52.227-19(June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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CPT is provided "as is" without warranty of any kind, either expressed of implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is the Health Care Financing Administration and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "ACCEPT".
FOURTH EDITION ("CPT")

Disclaimer of Warranties and Liabilities.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "ACCEPT".

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Auxilary Aids & Services

For information about the availability of beneficiary auxiliary aids and services, please call our Beneficiary Contact Center at 800-833-4455.

Appeals Process

If you think Medicare should have paid for, or did not pay enough for, an item or service you received, you can file an appeal. If you request an appeal, ask your doctor or provider for any information related to the bill that might help your case. The last page of the Medicare Summary Notice (MSN) that you receive from Railroad Medicare explains your appeal rights. The page also explains how to file an appeal and gives the date that we must receive your appeal by.

There are five different levels in the appeals process. If you don’t agree with the first level of appeal you can request the second level. If you still don’t agree you can request the third level and then the fourth, and finally the fifth. Each level must be requested in sequential order. It is important to remember that the decision letter you receive at each level of appeal will explain additional appeal rights you may have. You should read these decision letters carefully.

First level – Redetermination – This is the first level of the appeals process and must be requested within 120 days from the date you received your MSN. We assume you received your MSN within five days from the date of the notice. To file an appeal, follow the instructions on your MSN and return the completed, signed form to our office at the following address:

Railroad Medicare – Palmetto GBA
Attn: Redeterminations
P. O. Box 10066
Augusta, GA 30999

Second level – Reconsideration – This is the second level of appeals and is requested if you are dissatisfied with the decision made during your first level of appeal. This must be requested within 180 days from the date of your redetermination decision. The second level of appeals is handled by the Qualified Independent Contractor (QIC), which is separate from Palmetto GBA. Information about the QIC is included on your Redetermination decision letter from Railroad Medicare. Reconsideration requests should be sent to the following address:

Q2Administrators, LLC
Part B South Operations
P. O. Box 183092
Columbus, OH 43218-3092

Third level – Administrative Law Judge (ALJ) – If you do not agree with the QIC’s decision made on your second level of appeal, you can request a hearing by an Administrative Law Judge. This request needs to be submitted within 60 days from the date of your reconsideration decision. For requests filed after January 1, 2013, the bill you are appealing must be more than $140.00. Details explaining where to send your request should appear on the reconsideration decision letter.
Fourth level – Medicare Appeals Council – If you disagree with the ALJ’s decision made on your third level of appeal, you have 60 days after you get your decision to ask for a review by the Medicare Appeals Council. Follow the directions you got from the ALJ to ask for a review by the Medicare Appeals Council.
Fifth level – Review by a Federal District Court – If you wish to appeal the decision of the Medicare Appeals Council on your fourth level of appeal, you have the right to request a review by a Federal district court. The bill you are appealing must be more than $1,430 for requests filed on or after January 1, 2014. Follow the directions in the Medicare Appeals Council decision to request a review by a Federal district court.

If you have questions about your Railroad Medicare claim, you can call our toll-free Customer Service Line at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. For the hearing impaired, call TTY/TDD at 877-566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours Customer Service Representatives are available.

last updated on 07/01/2015

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