Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2020 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
Palmetto GBA is publishing the following Frequently Asked Questions (FAQs) based upon data analytics identifying topics generating a high volume of telephone inquiries between October 1, 2019, through December 31, 2019. We hope the answers to the questions below help you maximize your time by reducing your need to contact the Provider Contact Center (PCC).
FAQs Related to Highest Inquiry Categories:
Question: When did CMS being to require one calendar year as timely filing?
Answer: All claims for services furnished on or after Jan 1, 2010, must be filed to the Medicare contractor no later than one calendar year (12 months) from the date of service or Medicare will deny those claims. You may refer to MM6960, (PDF, 74 KB) MM7080 (PDF, 78 KB) and New Maximum Period for the Submission of Medicare Claims podcast.
Question: What options do providers have to obtain the status of a claim from their Medicare Administrative Contractor (MAC)?
Answer: Providers have a number of options to obtain claim status from MACs:
The electronic 276/277 process is recommended since many providers are able to automatically generate and submit 276 queries as needed, eliminating the need for manual entry of individual queries or calls to a contractor to obtain this information. Further information is available on the CMS website.
Question: What is the escalation process used in the Provider Contact Center (PCC)?
Answer: Palmetto GBA follows a PCC triage procedure as described in CMS guidelines. According to the guidelines in the Medicare Contractor Beneficiary and Provider Communications Manual (Pub. 100-09), chapter 6, sections 30.1 and 30.2, “the contact center shall be able to route general inquiries within the PCC to the system or person best equipped to respond, with a minimal degree of transfer.”
If the representative is unable to resolve an issue, a callback is offered. If a callback is unable to resolve and requires other operational assistance, then it is possible for the inquiry to be transferred without intervention to the provider to the next level for assistance. We work as a team to resolve issues.
Question: In the last quarter, what are the top reason codes providers called the PCC for an explanation?
Answer: Inquiry data for October 1 through December 31, 2019 show provider frequently called the PCC concerning claims with the following reason codes:
JM Part A
Don't see your question in the list above? Contact us and we'll help you find an answer.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 07/23/2020