By using eServices, providers can electronically submit an appeal request and PDF attachments online. Once submitted, you will receive a confirmation from Palmetto GBA indicating that the appeal has been received. For more information please review the Appeals Section in the eServices manual (PDF, 7.95 MB).

You may also download the forms from and submit them via postal mail or fax.

  • Please enter the data in the PDF form, include your first and last name. You can now print the form.
  • Once the form(s) is/are completed, attach the complete medical record (if applicable) and mail to the address indicated on the form. The Appeals form can be downloaded from our website.
  • Or, you have the option to submit requests for a redetermination and the medical record via fax at (803) 699–2425
  • First level of appeal: redetermination. Timeframe: 120 days from the date of the initial determination. Services that are "returned to provider" with remark code MA130 must be corrected and resubmitted, and not appealed.

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Provider Contact Center: 877-567-7271

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