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  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 SheetAppeals Status ToolAppeals Timeliness CalculatorProvider Adjustments Denied for Medical Necessity or After an Appeal Has Been SubmittedWhat is My Appeal Status? ModuleAppeals and Clerical Error Reopenings ModuleHow to Use Modifiers to Indicate the Status of an Advanced Beneficiary Notice (ABN)Fully Favorable Decisions: Part A and Part B AppealsC2C's Top Three Appeals CategoriesAppeals Overview for Providers ModuleGeneral Appeals InformationShorten Appeals Decision Times by Avoiding Duplicate Appeals RequestsGet Your First-Level Appeal Letters Delivered ElectronicallyCan I Appeal My Claim Denial? ModuleClarification of the First Level Appeal Decision LetterMaximus Federal Services, Inc. Is the Qualified Independent Contractor (QIC) for the Part A West JurisdictionGuide to Understanding the Limitation of the Scope of Review on Redeterminations and Reconsiderations of Certain ClaimsMedicare Redetermination Notices Mailing AddressNotification 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 JurisdictionsPart A East Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process DemonstrationAppeal Levels and Timely Filing Limits: Helpful InformationInstead of a Written Redetermination Consider Having Your Claim ReopenedAvoid Processing Delays and Send the Overpayment Demand Letter with Your Appeal RequestAdding late charges in DDEFax Number, Address, and Correct Format for Submitting RedeterminationsAppealing an Overpayment Subject to Limitation on RecoupmenteServices Appeals FeatureRedetermination: First level Appeal Form