| Question | Resources |
| Is my patient enrolled in a Medicare Advantage plan (HMO)? |
The Palmetto GBA IVR can now tell you if a patient is enrolled in a Medicare Advantage plan and the name of the plan.
Important: please verify this information with your patients directly, since there can be delays in updating the eligibility file (Common Working File) when a patient changes plans through Social Security. |
| Is Medicare primary or secondary for my patient? |
Before calling, verify the patient's insurance information, then use the Palmetto GBA MSP Lookup tool to find out whether Medicare should be primary or secondary. Access the tool directly from the Ohio or West Virginia home page.
Important: if changes are needed in a patient's insurance records through Medicare, please ask the patient to contact the Coordination of Benefits Contractor at (800) 999-1118. |
| My claims are being denied or rejected due to NPI problems- why? |
Palmetto GBA is developing a step-by-step troubleshooting guide for NPI questions. Until that guide is developed, please access the NPI Resource link on the Palmetto GBA Web site for information on specific questions. |
| Why was I paid less than the fee schedule amount? |
Reimbursement can be reduced for many reasons, including:
- The Correct Coding Initiative (bundling)
- Multiple procedure reductions for some surgeries, imaging studies and other diagnostic procedures
- The global surgical package reimbursement
- Mental health related services
For detailed information about these and other reasons for reduced reimbursement, refer to the FAQ 'Why was my payment reduced or denied?' |
| The IVR says my claim is not on file. Will you verify that? |
Palmetto GBA representatives and the IVR use the same computer system to verify receipt of your claim. Because the status of your claim is available through the IVR, CSRs are unable to assist with these questions.
Tip: if you have submitted multiple claims for the same service, follow the steps in the next row down. |
| My claim denied as a duplicate. How do I find the claim that was paid? |
- the IVR will tell the provider about the claim saying zero allowed and zero paid
- the IVR will then ask do you want specific information about this claim hit option 3 (it will tell you about each line item of that duplicate claim)
- the IVR will then say otherwise press 2 to continue (the provider will need to press 2)
- the IVR will then ask do you want to hear about another claim for the same date of service press 1
Dial (877) 567-9232, then:
- Choose Option 3 to go to the IVR
- Press 1 for a touch tone phone
- Choose Option 2 for claim status
- Enter the 7-digit PTAN (if PTAN begins with letter, press # to choose appropriate alpha-prefix)
- Enter the patient's Medicare Number
- Enter the 7-digit date of service. For duplicate claims, the IVR will tell you that there is zero allowed and zero paid for the claim. Once the denial message is given:
- 'Do you want specific information about this claim?' Choose option 3 for additional information to confirm the duplicate claim. The IVR will tell you about each line item of that duplicate claim.
- 'Otherwise': choose option 2 to continue
- 'Do you want to hear about another claim for the same date of service?' Choose option 1 for other claims processed for the same date of service.
*If there are multiple denials, then steps 7-9 may need to be repeated. |