Cost Report Appeals

Palmetto GBA has subcontracted with National Government Services (NGS) to assist in providing cost report appeal services for Jurisdiction M (JM) for Part A since August 2015. Palmetto GBA serves as Medicare Administrative Contractor (MAC) for all South Carolina and North Carolina individual appeals received on or after January 1, 2020 and certain aged appeals received prior to January 2020. NGS serves as the contracted MAC for group appeals and individual appeals for Virginia, West Virginia and select North Carolina and South Carolina providers. NGS is designated to receive all JM appeals on behalf of Palmetto GBA. The current Appeal Support Contractor (ASC) is Federal Specialized Services (FSS).

If there are any questions related to these appeal filing instructions, please contact Dana Johnson at NGSCostReportAppeal2@anthem.com.

For Appeals to the Intermediary
Information and procedures for filing an appeal before the Medicare Administrative Contractor (MAC) are available in Part I of the Provider Reimbursement Manual, Chapter 29 (PRM-1). Reference the chart below for amount in controversy requirement and contacts for filing.

All correspondence/documentation should be submitted to FSS and NGS in electronic format. Ensure that any Adobe attachments are legible. Providers should submit Excel spreadsheets where applicable. The subject line of the email should list the case number, provider name, provider number, fiscal year end and the nature of the correspondence: For example: "Subject: Case No., ABC Provider, Provider No. 12-3456, FYE XX/XX/XXXX, Final Paper."

For Appeals to the Provider Reimbursement Review Board (PRRB)
Information and procedures for filing PRRB appeals are available on the PRRB website: Effective November 1, 2021, all filings must be submitted electronically using the PRRB Electronic Filing System, Office of Hearings Case and Document Management System (OH CDMS) unless an exemption granted under Rule 2.1.2 applies. OH CDMS is a web-based portal for parties to enter and maintain their cases and to correspond with the PRRB. Access to the system is granted to registered users, as needed, based on their roles. Access to specific cases is limited to the parties of each case, including party representatives. 

Individuals registering for access to OH CDMS should allow for up to 10 days to complete registration as it is a multi-step process to obtain secure access to the web-based portal itself and to OH CDMS. Follow the link above for the most recent instructions for filing appeals and using OH CDMS.

Parties should review PRRB Rule 1.4 concerning Confidential Information prior to submitting documentation in OH CDMS. 

If an exemption to file in OH CDMS granted under Rule 2.1.2 applies, then hard copy filing must be submitted according to instructions in the chart below.