Why must providers use available self-serve tools for certain actions instead of speaking with a Palmetto GBA customer service representative?


Answer
The Centers for Medicare & Medicaid Services (CMS) requires providers to use the Palmetto GBA eServices portal or the Interactive Voice Response (IVR) system to access claim status and beneficiary eligibility information.

The Palmetto GBA eServices portal provides additional tools to assist the provider community. Review the eServices User Guide (PDF, 8.33 MB) to learn about available eService functions.

The process of using these tools allows Palmetto GBA to meet CMS requirements and our customer service representatives (CSRs) to assist callers with more complex inquiries which cannot be answered through the above-mentioned self-service tools.

Resources

CMS Reference
CMS Internet Only Manual, Publication 100-09, Chapter 6, Section 50.1 (PDF, 1.32 MB), "Providers shall be required to use IVRs to access claim status and beneficiary eligibility information. CSRs shall refer providers back to the IVR if they have questions about claims status or eligibility that can be handled by the IVR... Each MAC has the discretion to also require that providers use the Internet-based provider portal for claim status and eligibility inquiries if the portal has these functionalities."





Last Updated: 03/01/2021