- Filing an Appeal
- Frequently Asked Questions
- Helpful Websites
- Overpayment Appeals
- Which Form Do I Use?
eServices Appeals Feature
Palmetto GBA has enhanced eServices with new appeals features. Part A and home health and hospice (HHH) providers actively using eServices and have access to the Claims Inquiry tab can get an up-to-date appeals status, view and download decision letters and more. Please contact your eServices administrator for access to the Claims Inquiry tab if you do not already have access.
Do you want to learn about all of the new appeals enhancements? View our on-demand webcast to learn more.
Submitting Appeals via eServices Portal
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 User Manual (PDF, 8.55 MB).
You may also download the forms from Palmetto GBA website and submit them via U.S. 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 at: Jurisdiction J Part A, Jurisdiction M Part A, HHH.
- 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.