Appeals

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
  • When attempting to retrieve letters from eServices, be sure to use capital letters in the claim number
  • Do not have spaces before or after the claim number
  • Do not use special characters
• 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