Cost Report Appeals

Published 06/23/2023

Palmetto GBA has subcontracted with National Government Services (NGS) to assist in providing cost report appeal services for Jurisdiction M (JM) for Part A since August 2015. Palmetto GBA serves as Medicare Administrative Contractor (MAC) for all South Carolina and North Carolina individual appeals received on or after January 1, 2020 and certain aged appeals received prior to January 2020. NGS serves as the contracted MAC for group appeals and individual appeals for Virginia, West Virginia and select North Carolina and South Carolina providers. NGS is designated to receive all JM appeals on behalf of Palmetto GBA. The current Appeal Support Contractor (ASC) is Federal Specialized Services (FSS).

If there are any questions related to these appeal filing instructions, please contact Dana Johnson at NGSCostReportAppeal2@anthem.com.

For Appeals to the Intermediary
Information and procedures for filing an appeal before the Medicare Administrative Contractor (MAC) are available in Part I of the Provider Reimbursement Manual, Chapter 29 (PRM-1). Reference the chart below for amount in controversy requirement and contacts for filing.

All correspondence/documentation should be submitted to FSS and NGS in electronic format. Ensure that any Adobe attachments are legible. Providers should submit Excel spreadsheets where applicable. The subject line of the email should list the case number, provider name, provider number, fiscal year end and the nature of the correspondence: For example: "Subject: Case No., ABC Provider, Provider No. 12-3456, FYE XX/XX/XXXX, Final Paper."

For Appeals to the Provider Reimbursement Review Board (PRRB)
Information and procedures for filing PRRB appeals are available on the PRRB website: Effective November 1, 2021, all filings must be submitted electronically using the PRRB Electronic Filing System, Office of Hearings Case and Document Management System (OH CDMS) unless an exemption granted under Rule 2.1.2 applies. OH CDMS is a web-based portal for parties to enter and maintain their cases and to correspond with the PRRB. Access to the system is granted to registered users, as needed, based on their roles. Access to specific cases is limited to the parties of each case, including party representatives. 

Individuals registering for access to OH CDMS should allow for up to 10 days to complete registration as it is a multi-step process to obtain secure access to the web-based portal itself and to OH CDMS. Follow the link above for the most recent instructions for filing appeals and using OH CDMS.

Parties should review PRRB Rule 1.4 concerning Confidential Information prior to submitting documentation in OH CDMS. 

If an exemption to file in OH CDMS granted under Rule 2.1.2 applies, then hard copy filing must be submitted according to instructions in the chart below. 

For Medicare Administrative Contractor (MAC) Appeals

For Provider Reimbursement Review Board (PRRB) Appeals

Amount in controversy:

$1,000 – $9,999

Send request to the ASC:

Federal Specialized Services (ASC)

Intermediary@fssappeals.com


and
 

Intermediary Hearing Officer

Paul.Crofton@fedspecserv.com


Copy:

NGSCostReportAppeal2@anthem.com

 

If filing documents with FSS and NGS electronically is not an option for the provider, use the addresses below to file unbound correspondence:

U.S. Mail or Courier Service

Federal Specialized Services

Intermediary Appeals

1701 S. Racine Avenue

Chicago, IL 60608-4058

 

Copy:


U.S. Mail

National Government Services, Inc

Attn: Cost Reporting Unit

P.O. Box 7040

Indianapolis, IN 46207-7040


For Courier service:
National Government Services, Inc

Attn: Cost Reporting Unit

220 Virginia Avenue

Indianapolis, IN 46204

 

Amount in controversy:

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


Only if an exemption from filing in OH CDMS has been granted, send request to PRRB:


U.S. Mail or Courier Service

Provider Reimbursement Review Board CMS Office of Hearings

7500 Security Boulevard

Mail Stop: B1-01-31

Baltimore, MD 21244-1850

and


Federal Specialized Services (ASC)

prrb@fssappeals.com


Copy:

NGSCostReportAppeal2@anthem.com

 

If filing documents with FSS and NGS electronically is not an option for the provider, use the addresses below to file unbound correspondence:


U.S. Mail or Courier Service

Federal Specialized Services

PRRB Appeals

1701 S. Racine Avenue

Chicago, IL 60608-4058

Copy:


U.S. Mail

National Government Services, Inc

Attn: Cost Reporting Unit

P.O. Box 7040

Indianapolis, IN 46207-7040

For Courier Service:

National Government Services, Inc

Attn: Cost Reporting Unit

220 Virginia Avenue

Indianapolis, IN 46204


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