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Jurisdiction 11 Part B
Beneficiary Eligibility Denials

Denial Reason, Reason/Remark Code(s)
  • PR-26: Expenses incurred prior to coverage
  • PR-27: Expenses incurred after coverage terminated  

Resolution/Resources: Verify patient eligibility prior to submitting claims to Medicare through the Palmetto GBA Online Provider Services (OPS) tool or Interactive Voice Response (IVR) unit.

Online Eligibility Verification through OPS

  • All providers that have an EDI Enrollment Agreement on file may register to use this tool. If you haven't already registered, please consider doing so.
  • Access the introductory article to learn more by selecting the 'Introducing Online Provider Services' graphic on the top of any of our main state Web pages 
  • Please note: Only one provider administrator per EDI Enrollment Agreement/per PTAN/NPI combination performs the registration process. The provider administrator can then grant permission to additional users related to that PTAN/NPI.
  • Billing services and clearinghouses should contact their provider clients to gain access to the system
  • Specific instructions for accessing beneficiary eligibility information through OPS are available in the OPS User Manual (PDF, 2.61 MB)

 

last updated on 09/16/2013
ver 1.0.43