Last Modified: 10/4/2018
Location: FL, PR, USVI
Business: Part A
Appeals forms
Providers, participating physicians, and other suppliers have the right to appeal claim decisions. Appeals must be submitted using the following forms:
1st level: Request for redetermination of a Part A claim 
2nd level: Reconsideration request form -- C2C Innovative Solutions, Inc. 3rd level: Hearing by an administrative law judge
Exception for timely filing
There are a few exceptions which allow an extension to the 12-month timely filing period. View the following resources for additional information.
Additional resources
Learn how an individual can become an authorized beneficiary representative for appeals -- CMS 1696: Appointment of representative 
Understand when to file an appeal and the time limits for filing requestsFirst Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
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