Redetermination Requests

Please submit all redetermination requests to Palmetto GBA. The simplest, most efficient way to submit a redetermination is through eServices portal. It is fast and easy and allows you to also submit supporting documentation. You can also complete the Part B Redetermination Form electronically from our website. Then print the form for your records and mail or fax the form and any supporting documentation to Palmetto GBA. Whether you choose to submit your request online via eServices, to fax or mail your request, you must include any supporting documentation.

You may also mail redetermination requests to:

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

Fax number for Part B redetermination requests is (803) 699-2427.

Other Tips for all Redetermination Requests
All redetermination requests must be submitted within 120 days of the date of the initial determination to be considered timely.

Redetermination requests submitted must contain the following information to be considered valid requests:

  • Beneficiary name
  • Medicare Beneficiary Identifier (MBI/HIC)
  • The specific service(s) and/or item(s) for which the redetermination is being requested
  • The specific date(s) of the service
  • The name of the party or the representative of the party requesting the Redetermination

Redetermination requests submitted without all of the above information will be returned as incomplete. Once completed, you may resubmit your request within the 120-day time frame.

Redeterminations submitted by mail or fax must still be in writing. Any written requests must contain all of the above information.

Submit any additional supporting documentation with your redetermination request. It is not necessary to provide copies of National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs). As appropriate, please remember to include a legible, valid signature.

If the redetermination involves an overpayment situation, include a copy of the overpayment demand letter and any spreadsheet sent with the demand letter. Please let us know if the overpayment is in relation to a CERT, RAC or other type of overpayment.

Redeterminations, regardless of the method of submission, will still be completed within 60 days of receipt of the request. eService submissions reach us immediately. The receipt date for faxed requests received after 4:30 p.m. ET will be considered as the next business day.

Faxing Redeterminations
No special preparation is necessary for redetermination requests submitted this way. The redetermination form can serve as the fax cover sheet. All current required elements remain in effect for any requests sent via fax. The redetermination fax number may only be used for redetermination requests. Do not fax any other requests or information to this number. Please check fax numbers carefully. Please limit the number of pages per redetermination request to no more than 150. Please do not use this fax number for any other types of requests.

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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