Quarterly Frequently Asked Questions (FAQs): April 2020
Question: Will I receive a letter once my appeal is finalized?
Answer: For any redetermination that results in an unfavorable decision, the provider will receive a letter by mail or through eServices via eDelivery. For providers enrolled in eDelivery, a secure inbox message will be sent with a link to the letter. To receive eDelivery of your Medicare redetermination letters, providers must be signed up for eServices and select eDelivery.
Question: When will a Remittance Advice (RA) be received for a favorable decision?
Answer: When a fully favorable decision is rendered, the claim is adjusted to allow for payment. When processing of the adjustment has been completed, the adjustment will appear on the Remittance Advice and you typically receive your RA within 30 days of the claim adjustment date. Access the claim details on the Claim Status Inquiry screen on Palmetto GBA’s eServices portal.
Claim Status FAQ
Question: Why can’t I find my claim through the IVR?
Answer: If you are unable to locate a claim through the IVR, verify the provider and beneficiary information entered for the query, confirm the claim was submitted by you or your billing company, or, if an electronic claim, the claim may have been rejected at the point of submission and did not enter the claim processing system. Review your 277CA electronic claim submission acknowledgement report to determine if the claim was rejected and must be corrected and resubmitted.
If the IVR does not locate a claim on file, the CSA will not be able to locate the claim (considering all information entered/provided regarding patient and provider are correct)
Claim Denials FAQ
Question: My claim denied due to a date of death on file, but the beneficiary is not deceased. How does the patient’s date of death get corrected?
Answer: The beneficiary will need to contact the Social Security Administration (SSA) to have the date of death removed from their record. Once the date of death has been removed from the beneficiary’s record, the claim should be resubmitted for processing. If the claim is resubmitted after timely filing (more than one year from the date of service), the claim cannot be appealed by the provider.
General Information FAQ
Question: Does Medicare cover prescription medication?
Answer: Palmetto GBA is unable to address drug plan coverage and criteria.
Medicare prescription drug coverage is an optional benefit offered under Medicare Part D. To determine if a prescription medication is covered, contact the beneficiary for the name of their chosen drug plan and contact the drug plan.
Question: I can’t find my patient’s new Medicare Beneficiary Identifier (MBI). How can I submit claims?
Answer: Patients should present their Medicare card that identifies the patient’s MBI number. When patients do not present their Medicare card, you may use the MBI Lookup tool in the Palmetto GBA eServices online portal to obtain a patient’s MBI number. Identifying a patient MBI number through eServices requires a user to be logged in. Once logged in, click on the MBI Lookup tab located in the header of the portal. All required (*) fields must be complete: Beneficiary’s Last Name, First Name, Date of Birth, and Social Security Number.
Question: Is the eligibility date for Medicare Part A and B the same?
Answer: No. Some beneficiaries are automatically enrolled in Medicare Part A and others sign up when they’re first eligible. Certain people may choose to delay Medicare Part B enrollment, giving the patient different effective dates for Part A and Part B coverage.
Provider Eligibility FAQ
Question: Why did my claim reject or deny for missing incomplete NPI number?
Answer: The claim rejected due to the NPI submitted on the claim. The NPI may have been incorrectly entered, no longer effective, or the NPI was not linked to the billing provider.