Appeals

Claims can be denied for a variety of reasons. Find out how you can file an appeal if you feel a claim was denied incorrectly.


Submitting an Appeal

  • Providers are encouraged to submit their appeals via Palmetto GBA's eServices portal
    • By using eServices, providers can submit the appeal request and the complete medical record 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
  • You may also complete the forms electronically on our website
    • Please include your first and last name. You can then print the form.
    • Attach the complete medical record and mail to the address indicated on the form. The appeals form can be found on our website.
  • 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, not appealed.
  • Second level of appeal: reconsideration. Timeframe: 180 days from receipt of redetermination. Submit this form to the Qualified Independent Contractor.

Appeal Letters

  • Appeal letters, also known as Medicare Redetermination Notices (MRNs), are sent with the results for partially paid services and denied services

Status Lookup Tools





Appeals Articles


Medicare Parts A and B Appeals Process CMS Fact SheetOutpatient Prospective Payment System (OPPS): Redetermination Requests for Drugs Acquired under 340B ProgramAppeals Timeliness CalculatorAppeals Status ToolProvider Adjustments Denied for Medical Necessity or After an Appeal Has Been SubmittedAppeals Overview for Providers ModuleCan I Appeal My Claim Denial? ModuleAppeals and Clerical Error Reopenings ModuleFully Favorable Decisions: Part A and Part B AppealsHow to Use Modifiers to Indicate the Status of an Advanced Beneficiary Notice (ABN)C2C's Top Three Appeals CategoriesShorten Appeals Decision Times by Avoiding Duplicate Appeals RequestsGeneral Appeals InformationGet Your First-Level Appeal Letters Delivered ElectronicallyAppealing an Overpayment Subject to Limitation on RecoupmentClarification of the First Level Appeal Decision LetterGuide to Understanding the Limitation of the Scope of Review on Redeterminations and Reconsiderations of Certain ClaimsMedicare Redetermination Notices Mailing AddressAvoid Processing Delays and Send the Overpayment Demand Letter with Your Appeal RequestPart A East Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process DemonstrationAppeal Levels and Timely Filing Limits: Helpful InformationNotification of the 2021 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge (ALJ) Hearing or Federal District Court ReviewC2C Innovative Solutions, Inc.: Qualified Independent Contractor (QIC) for Part A East JurisdictionsInstead of a Written Redetermination Consider Having Your Claim ReopenedAdding late charges in DDERedetermination: First Level Appeal FormFax Number, Address, and Correct Format for Submitting RedeterminationsFrequently Asked Questions: AppealsWhat is My Appeal Status? ModuleeServices Appeals Feature