End of the Month Provider Inquiries
Increased record-keeping and financial activities at month’s end generate a sudden and higher-than-normal call volume to Palmetto GBA’s provider contact center (PCC), and this year the end-of-month coincides with the Memorial Day holiday closure of the PCC.
In order to best serve the provider community, Palmetto GBA recommends providers consider the following actions before calling the provider call center:
- Review your Medicare Remittance Advice (RA) for the denied/rejected claims and identify the claim adjustment reason and remark codes. These codes are located on the last page of your Palmetto GBA RA and will define the reason(s) for rejections and denials and will indicate if a claim has been afforded appeal rights.
- Use Palmetto GBA’s eServices secure portal for claim status and duplicate copies of remittance advice
- Check the status of your redeterminations (first level appeals) submitted by mail or fax using Palmetto GBA’s Jurisdiction J and M Redetermination Status Tool (JJ Part B, JM Part B). If you submitted your reopening or redetermination through eServices, check the status through Palmetto GBA eServices tool. The Palmetto GBA eServices User Manual can answer questions and guide you through the eServices portal.
- Check the status of your provider enrollment application using Palmetto GBA’s Provider Enrollment Application Status Tool
- CMS requires providers use the Palmetto GBA Interactive Voice Response System (IVR) for claim status and eligibility inquiries.
- Save time and avoid authentication with every call to the Palmetto GBA by utilizing ePass
- Through the IVR, follow the first-time authentication steps by selecting Option 5 for ePass and then Option 2 to receive ePass; or
- Request your ePass verbally while speaking with a Customer Service Agent (CSA) following first-time authentication
- All Palmetto GBA forms and links to CMS enrollment forms can be found on the Palmetto GBA website
If you do call the provider contact center, be sure to have the following information ready at the time you place the call:
- PTAN, NPI and last five digits of your tax identification number
- Beneficiary's full name as it appears on their Medicare card
- Medicare Beneficiary Identifier (MBI/HIC)
- Any other information or examples needed to discuss your question, claim or situation