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 request 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 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. 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) 699–2427

You may also mail redetermination requests to:

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

Status Lookup Tools





Appeals Articles


Medicare Parts A and B Appeals Process CMS Fact SheetAppeals Timeliness CalculatorAre You Tired of Writing in to Request a Simple Claim Correction (Reopening)?Redetermination Time Limit: ReminderAppeals Overview for Providers ModuleGeneral Appeals InformationShorten Appeals Decision Times by Avoiding Duplicate Appeals RequestsRedetermination Status ToolTelephone Reopening TipsClarification of the First Level Appeal Decision LetterAppeal Levels and Timely Filing Limits: Helpful InformationeServices Forms for Requesting a Reopening or RedeterminationClaim Rejections and Billing ErrorsNotification 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 ContractorInstead of a Written Redetermination Consider Having Your Claim ReopenedAvoid Processing Delays and Send the Overpayment Demand Letter with Your Appeal RequestHow to Submit Part B Redetermination RequestsAppealing an Overpayment Subject to Limitation on RecoupmentGet Your First-Level Appeal Letters Delivered ElectronicallyAppeal Requests to Change the Quantity BilledTypes of ReopeningsMedically Unlikely Edits (MUE) Denials for DrugsWhen to File an Appeal and When an Appeal Should Not be FiledBilateral Procedures and ModifiersCMS MLN Fact Sheet: Medical Record Maintenance and Access RequirementsMedically Unlikely Edits (MUEs)GZ and GY HCPCS Modifier UseAppeal Rights: Know the RulesFully Favorable Decisions: Part A and Part B Appeals