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Jurisdiction 11 Part A
Appeals

Access information regarding your appeal rights on the Palmetto GBA Appeals page:

  • Appeals forms are located on this page. You may complete the forms electronically then print and sign the forms, attach supporting documentation and mail to the address indicated on the forms.
    • Or you have the option to submit requests for a redetermination and supporting documentation 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.
  • Second level of appeal: reconsideration. Timeframe: 180 days from receipt of redetermination. Submit this form to the Qualified Independent Contractor (address is located on form).

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General Appeals Information06/10/2013
Providers Cannot Make an Adjustment to a Claim Once it has Been Through the Redetermination Process06/06/2013
MAXIMUS Federal Services: Qualified Independent Contractor (QIC) for Part A East and West Jurisdictions05/20/2013
Calendar Year 2013 Update: Amount in Controversy Requirements for Administrative Law Judge (ALJ) and Federal District Court Appeals05/10/2013
Alert: Redetermination Requests Are Inappropriately Being Sent to the Medical Review Department and Cannot be Forwarded to the Appeals Department for Processing05/06/2013
Hints for Submitting Medical ADR (Additional Documentation Requests) or Appeal Requests05/06/2013
Appeals, Adjustments and the D9 Claim Change Reason (Condition) Code01/23/2013
Redetermination: 1st Level Appeal Form01/08/2013
Administrative Law Judge (ALJ) Decisions: Impact on Some Inpatient Medicare Claims11/16/2012
What is the Status of My Appeal?10/02/2012
Redetermination Dismissals Job Aid09/04/2012
Clarification of the First Level Appeal Decision Letter05/30/2012
Fax Number for Submitting Redeterminations02/14/2011
Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Appeals via Facsimile and/or via a Secure Internet Portal/Application06/16/2010
Change in the Amount in Controversy Requirement for Administrative Law Judge Hearings and Federal District Court Appeals05/12/2010

 

last updated on 6/01/2013
ver 1.0.42