Medicare Advantage Contract Submission for Wraparound Payment
Published 02/09/2023
For each Medicare Advantage (MA) plan, please submit a documented estimate of the average visit payment for the MA enrollees.
Documentation should include a cover letter with the provider list, as well as a contact name, and should be signed by the contact.
Each MA contract should include the following:
- Contract number;
- Provider name and MA contract name;
- Contract dates;
- Effective dates; and
- Signatures from the provider and the MA contract representative
The rate calculation should include the following:
- Contract number;
- Procedure codes;
- Units;
- Rates;
- Payment amounts; and
- MA payment rate per visit
A detailed claims list that supports the information in the rate calculation should also be included: Detailed Claim List Form (XLSX).
The information can be sent via email to JMReimbursement@palmettogba.com or by mail to the address below:
Provider Reimbursement
AG-330
2300 Springdale Drive, Building One
Camden, SC 29020