Appeals
Published 04/20/2016
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 Status Tool
- Administrative Law Judge (ALJ) (Third Level) Status Lookup Tool: HHS.gov website