Palmetto GBA reminds physicians to send redetermination requests to Appeals Department

Last week, Palmetto GBA (a Medicare contractor) noted an increasing trend of clinicians sending redetermination requests to its Medical Review Department after their additional development requests (ADRs) resulted in a denied claim.

Palmetto is reminding physicians that redetermination requests should be sent to the Appeals Department, not to the Medical Review Department. They also noted that if the requests are mistakenly sent to the medical review staff without the redetermination request form, staff cannot forward the documentation to Appeals without the form. Physicians have 12 days to file an appeal after a claim has been denied.