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Last Modified: 11/8/2017 Location: FL, PR, USVI Business: Part B

Appeals FAQs

Q: Can I resubmit or adjust a claim when an appeal is processing?
A: It is not recommended to submit a new or adjusted claim when the appeal is pending.
Resubmitting or adjusting the claim does not reduce the processing timeframe for the appeal. In fact, it may result in an appeal dismissal or delay the processing time for the outstanding appeal. This matter affects appeals at various levels.
Note: Adjustments to the initial claim or claim resubmission for the same service on the same date of service do not extend the appeal rights on the initial determination. Click here for information on when to file an appeal for each of the five levels.
Source: Centers for Medicare & Medicaid Services (CMS) internet-only manual (IOM) 100-04, Chapter 29 external pdf file
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Source: First Coast Education Action Team
First 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.