Appeals

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 eServices today
  • Some denials can be adjusted 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. Time frame: 180 days from receipt of redetermination. Submit this form to the Qualified Independent Contractor (address is located on form).

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: