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:

  • Avoid future appeals by using the Denial Resolution
  • Submit first level appeal and reopening requests using the Secure Forms function of the free eServices portal
  • For eDelivery of appeal letters, sign up for eServices today
  • Some denials can be adjusted via telephone reopening; please call 877–567–7271
  • Appeals forms: complete the forms electronically then print the forms, attach supporting documentation, and then mail to the address on the form
  • First level of appeal: redetermination. Time frame: 120 days from the date of the initial determination. Services that are "rejected as unprocessable" with remark code MA130 must be corrected and resubmitted, not appealed.
  • Second level of appeal: reconsideration. Time frame: 180 days from receipt of redetermination. Submit this form to the Qualified Independent Contractor (address is located on form).

Fax number for Part B redetermination requests: (803) 870–0139

You may also mail redetermination requests to:

Palmetto GBA - JJ Part B - AG-655
P.O. Box 100306
Columbia, SC 29202–3306

Status Lookup Tools:




Medicare Parts A and B Appeals Process CMS Fact SheetAppeals Timeliness CalculatorAre You Tired of Writing in to Request a Simple Claim Correction (Reopening)?Telephone Reopening TipsRedetermination Time Limit: ReminderRedetermination Status ToolShorten Appeals Decision Times by Avoiding Duplicate Appeals RequestsClarification of the First Level Appeal Decision LetterAppeal Rights: Know the RulesSecond Level of Appeal: Reconsideration with the Qualified Independent ContractorClaim Rejections and Billing ErrorsAppeal Levels and Timely Filing Limits: Helpful InformationeServices Forms for Requesting a Reopening or RedeterminationInstead of a Written Redetermination Consider Having Your Claim ReopenedAvoid Processing Delays and Send the Overpayment Demand Letter with Your Appeal RequestHow to Submit Part B Redetermination RequestsGet Your First-Level Appeal Letters Delivered ElectronicallyAppeal Requests to Change the Quantity BilledTypes of ReopeningsWhen to File an Appeal and When an Appeal Should Not be FiledMedically Unlikely Edits (MUE) Denials for DrugsBilateral Procedures and ModifiersAppealing an Overpayment Subject to Limitation on RecoupmentMedically Unlikely Edits (MUEs)CMS MLN Fact Sheet: Medical Record Maintenance and Access RequirementsGZ and GY HCPCS Modifier UseFully Favorable Decisions: Part A and Part B AppealsNotification of the 2022 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge (ALJ) Hearing or Federal District Court ReviewGeneral Appeals InformationAppeals Overview for Providers Module

Last Updated: 05/12/2022