Need a Quick Answer?

Published 10/11/2022

If you need a quick answer to your Medicare question, you may be able to find it more quickly on the Palmetto GBA website than if you call the Provider Contact Center. With our search capabilities, a simple search from the Part B home page takes only seconds.

Based on your telephone calls to us, we know that your top questions include these:

Question Resources
Is my patient enrolled in a Medicare Advantage plan (HMO)? The Palmetto GBA IVR can 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 Part B home page.

Important: if changes are needed in a patient's insurance records through Medicare, please ask the patient to contact the Medicare Secondary Payer (MSP) Contractor at 1-855-798-2627 (TTY/TDD: 1-855-797-2627).
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
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. 

 


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