Last year, Palmetto GBA as your Fiscal Intermediary (FI) or Regional Home Health and Hospice Intermediary (RHHI) processed 16.9 million claims to almost 100 percent completion without a hitch. Providers filed the claims electronically; they passed all of the contractor’s edits, were processed, and paid electronically. Over $5.8 billion was paid in this manner. This is a rather amazing feat. However, a small fraction of the claims were not as fortunate. These claims encountered edits that were caused by system issues.

Whenever system issues arise, we are as anxious as you are to get the issue resolved as quickly as possible. Once a system issue is reported, we employ tactical efforts and follow our escalation procedures. The process not only involves you and Palmetto GBA, but it also involves other contractors, the Fiscal Intermediary Shared System (FISS) and the Enterprise Data Center (EDC). More complex issues requiring a system-wide correction may result in longer than normal time frames in an effort to test solutions prior to implementing. A high-level review of the process is listed below:

1. Palmetto GBA is notified of potential issue
2. Palmetto GBA verifies the issue
3. If verified as system issue, Palmetto GBA notifies FISS
4. If verified as data center issue, Palmetto GBA notifies EDC
5. Issue is placed on the Claims Processing Issues Log and is updated weekly via Web update and listserv e-mail
6. Once resolution is provided by FISS or EDC, Palmetto GBA alerts providers via the Claims Processing Issues Log
7. The processing of previously impacted claims may take several days or weeks depending on the volume. Please be patient.

The information posted on the Claims Processing Issues Logs is the same information provided to Palmetto GBA’s Customer Service Representatives (CSRs).  We post all known information on the logs.

Whenever we encounter system issues, please know we apologize for any inconvenience and work diligently to resolve the issues. If a provider would like to pursue an accelerated payment from Palmetto GBA while we work to resolve issues, please complete the Accelerated Payment Request Form (PDF, 16 KB).

It is important that you share the Claims Processing Issues Logs with your billing and collections representatives. Anyone can sign up to receive our Listserv messages which will alert you when an issue is identified and resolved. For more information and instructions on registering for the Palmetto GBA Web site listserv, select E-mail Updates.