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
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