Appeals

Claims can be denied for a variety of reasons. Find out how you can file an appeal if you feel a claim was denied incorrectly.


Submitting an Appeal

  • Avoid future appeals by using the Denial Resolution tool
  • Submit first level appeal and reopening requests using the Secure Forms function of the free eServices portal
  • For eDelivery of appeal letters, sign up for the eServices Portal
  • Some denials caused by clerical errors can be corrected via telephone reopening; please call 877–567–7271
  • 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. Second level of appeal: reconsideration. Time frame for submitting a reconsideration request is 180 days from the date of receipt of the redetermination decision. Submit your reconsideration request directly to the Qualified Independent Contractor (QIC). The address is located on the reconsideration request form and can also be found within the redetermination decision letter.

Fax number for Part B redetermination requests: (803) 870–0139

You may also mail redetermination requests to:

Palmetto GBA - JJ Part B - AG-655
P.O. Box 100306
Columbia, SC 29202–3306

Status Lookup Tools:





Appeals Articles


Medicare Parts A and B Appeals Process CMS Fact SheetAppeals Timeliness CalculatorAppeals Overview for Providers ModuleAre You Tired of Writing in to Request a Simple Claim Correction (Reopening)?Telephone Reopening TipsRedetermination Time Limit: ReminderRedetermination Status ToolFully Favorable Decisions: Part A and Part B AppealsGeneral Appeals InformationShorten Appeals Decision Times by Avoiding Duplicate Appeals RequestsClarification of the First Level Appeal Decision LetterAppeal Rights: Know the RulesNotification of the 2021 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge (ALJ) Hearing or Federal District Court ReviewSecond Level of Appeal: Reconsideration with the Qualified Independent ContractorClaim Rejections and Billing ErrorsAppeal Levels and Timely Filing Limits: Helpful InformationeServices Forms for Requesting a Reopening or RedeterminationInstead of a Written Redetermination Consider Having Your Claim ReopenedAvoid Processing Delays and Send the Overpayment Demand Letter with Your Appeal RequestHow can I check the status of my first level appeal?How to Submit Part B Redetermination RequestsGet Your First-Level Appeal Letters Delivered ElectronicallyAppeal Requests to Change the Quantity BilledTypes of ReopeningsWhen to File an Appeal and When an Appeal Should Not be FiledMedically Unlikely Edits (MUE) Denials for DrugsBilateral Procedures and ModifiersAppealing an Overpayment Subject to Limitation on RecoupmentMedically Unlikely Edits (MUEs)CMS MLN Fact Sheet: Medical Record Maintenance and Access RequirementsGZ and GY HCPCS Modifier Use