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)