Cost Report Appeals


Palmetto GBA is in a subcontracting arrangement with National Government Services (NGS) to provide cost report appeal services for the JM jurisdiction effective August 27, 2015. Palmetto GBA assumed responsibility for all South Carolina and North Carolina individual appeals received on or after January 1, 2020. In addition, Palmetto GBA will be responsible for an established aged workload of 125 individual S.C. and N.C. appeals. NGS will continue to perform subcontract work related to the JM workload on Palmetto GBA’s behalf. NGS follows the Centers for Medicare & Medicaid Services (CMS) required procedures and protocols related to this function, and is directly using our QMS policies and procedures. The JJ workload is completed by Palmetto GBA using QMS policies and procedures.

Palmetto GBA remains the prime contractor for the Audit and Reimbursement (A&R) services for the JM jurisdiction, including cost report appeals. Palmetto GBA provides direction to all of our subcontractors in the completion of the A&R workload.

On July 2, 2015, CMS announced that Federal Specialized Services, LLC (FSS) has full responsibility of the appeals support function. Appeals-related correspondence and MAC appeals-related correspondence should be sent to FSS. The address information is included below.

For MAC Appeals
For Provider Reimbursement Review Board (PRRB) Appeals
 

Amount in controversy:
$1,000 — $9,999

Amount in controversy:
$10,000 or more ($50,000 or more, in aggregate, for group appeal)

Send request to:
intermediary@fssappeals.com

If filing documents electronically is not an option for the provider, use the address below.

U.S. Mail or Courier Service

PRRB Appeals
Federal Specialized Services
1701 S. Racine Avenue
Chicago, IL 60608-4058

**Effective November 1, 2021 — All PRRB appeals are to be filed electronically via OH CDMS, unless an exemption applies. See Alert 21 and 22 at the PRRB Review Current Alert Web page**

Send Request to:

U.S. Mail or Courier Service

CMS Office of Hearings
7500 Security Boulevard
Mail Stop: B1-01-31
Baltimore, MD 21244-1850

and

prrb@fssappeals.com

If filing documents electronically is not an option for the provider, use the address below.

U.S. or Courier Service

PRRB Appeals
Federal Specialized Services
1701 S. Racine Avenue
Chicago, IL 60608-4058

Copy:
Preferred method for delivery

Via email to:
NGSCostReportAppeal2@anthem.com

If you are unable to send electronically, send unbound correspondence to:

Dana Johnson, Appeals Lead
National Government Services, Inc.
MP: INA101-AF42
Post Office Box 6474
Indianapolis, IN 46206-6474

For courier service:

8115 Knue Road
Indianapolis, IN 46250

Copy:
Preferred method for delivery

Via email to:
NGSCostReportAppeal2@anthem.com

If you are unable to send electronically, send unbound correspondence to:

Dana Johnson, Appeals Lead
National Government Services, Inc.
MP: INA101-AF42
Post Office Box 6474
Indianapolis, IN 46206-6474

For courier service:

8115 Knue Road
Indianapolis, IN 46250

Information and procedures for filing PRRB appeals are available on the PRRB website. Information and procedures for filing a MAC appeal is available in Part I of the Provider Reimbursement Manual, Chapter 29 (PRM-1).




Last Updated: 10/07/2021