Please Do Not Submit Duplicate Appeal Requests

As a Medicare Administrative Contractor (MAC), Palmetto GBA has 60 days to complete a redetermination decision. If you are not sure if your request has been received, please use the redetermination status tool on the Palmetto GBA website to check the status of your appeal. The status tool is located under Forms/Tools and will let you know if your request is being processed.

The following bullets include examples of situations that result in duplicate appeal requests:

  • One request is submitted via the eServices portal and another request is faxed or mailed
  • It is not necessary to submit separate requests in different methods. One submission, regardless of method, is sufficient.
  • One request is submitted via hard copy and another request is subsequently faxed 
  • It is not necessary to send separate requests by mail and by fax
  • One request is submitted as a hard copy and sent via certified mail. The same or next day, the exact same request is submitted hard copy in the same manner. Please send only one request.
  • One request is faxed and on the same day (or within the next couple of days) a second request is faxed
  • If your fax machine is skipping pages or not pulling the pages into the machine correctly, please have your fax machine serviced before sending any additional faxed appeal requests. Or, sign up for eServices, as this is the most efficient and effective method for submitting requests and also provides an e-mail confirming receipt by Palmetto GBA. If you think the original fax was not received, please contact the Provider Contact Center or check the redetermination status tool to confirm receipt before submitting a second request. It may take a few business days for your request to show up on our system. Please allow some time and check the status of your initial request to verify whether or not it was received before submitting a second request.
  • Be sure to include all documentation with your initial faxed request to prevent the need for submitting a second request. If you think the original fax did not contain all required documentation, please contact the Provider Contact Center. The Provider Contact Center will help you determine if the missing information is needed. If the missing information is needed, the Provider Contact Center will help get the missing information to the Appeals area.
  • Prior to faxing, be sure the request form is completed correctly
  • Verify the fax number prior to faxing the request to us. Sending your request to two different fax numbers within Palmetto GBA can result in duplicate requests if the original fax is forwarded to the Appeals department for processing. If you think you sent your request to an incorrect fax number, please contact the Provider Contact Center, or check the redetermination status tool before sending a second request.
  • One request is submitted with a spreadsheet listing each patient and date of service (DOS) being appealed (or with a copy of a Medicare Remittance Notice (MRN) with multiple claims highlighted). In addition, a separate appeal request form is submitted for each patient listed on the spreadsheet or MRN.

Please submit only one appeal request form with the spreadsheets or MRNs and not individual claim forms. If multiple issues are included, note the specific issue next to each beneficiary on the spreadsheet. The spreadsheet should contain all of the information needed to identify each patient and make clear what you are asking us to do. At a minimum, the spreadsheet should include the patients’ Medicare numbers and names, the dates of service and the procedure codes being appealed. If MRNs are submitted with the appeal, be sure to indicate which patients you are appealing. Remember, highlighting does not show when scanned. Indicate with a check mark (or some other obvious indicator) the claims to be reviewed. If they are all being appealed for the same reason, you do not need to send CMS 1500 claim forms* as long as the required information is on the appeal request form or attached spreadsheet.

*Note: If you send the CMS 1500 claim forms, place them after the spreadsheets or MRNs being submitted

An appeal request is submitted for each service on the claim.

Please indicate on the appeal request form all items you are appealing for the claim. Do not send a separate request for each service.

In some cases, redetermination requests are submitted, and within one to five days after the first submission a second request is submitted with one or two additional pages that were not included with the original submission. To ensure that the additional information is matched with your initial request, please consider the following:

  • Submit all documentation to support your appeal with the initial redetermination request
  • Hold off submitting your redetermination request, if at all possible, to allow submission of all documentation at one time. This will assure that everything submitted for that case is included in your review.

Instances where additional information is submitted later should be rare. Additional documentation will only be considered in cases where Palmetto GBA has not yet completed the redetermination decision. If the redetermination decision has been completed, a Reconsideration will have to be filed at the Qualified Independent Contractor (QIC). If you have to submit documentation after your appeal request has been sent, do so quickly and be sure to mark your second submission as follows: "Additional Documentation Submission for Redetermination request submitted on (DATE)."

If the only item that you are missing on your request is a copy of the remittance notice, please do not submit this separately. As long as your request included enough information to identify the claim and service being appealed, we do not need a copy of the remittance notice to complete the appeal.

To ensure confidence your appeal has been received, submit via eServices. Submitting an appeal request is easy using the eServices portal on the Palmetto GBA website. Once you have submitted the form, you will receive an email confirmation that the form was received by Palmetto GBA. Once the form has been accepted into our processing system, an additional message will be generated with the Document Control Number (DCN). Using the eServices method to submit your appeal requests provides a layer of confidence your appeal has been received.

There is no cost to the provider for registering and using eServices.

Palmetto GBA’s eServices is an Internet-based, provider self-service secure application. Palmetto GBA’s goal is to give the provider secure and fast access to their Medicare information seamlessly via our website through the eServices application.

You can participate in eServices if you have a signed Electronic Data Interchange (EDI) Enrollment Agreement on file with Palmetto GBA and have payment amounts on file. To find instructions on how to get one, go to the EDI section of PalmettoGBA.com.

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

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 

Click to Chat Now