Provider Contact Center (PCC) Frequently Asked Questions (FAQs): October 1 - December 31, 2019

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).

RTP/Status 7,060 
Financial 1,269
Denial/Reject Explained  6,790
Appeals 1,020
General 4,038
Billing  1,193

RTP/Status 8,900 
Financial 1,373
Denial/Reject Explained  6,657
Appeals 1,160
General 1,623
Billing  808

 

RTP/Status 6,293
Financial 3,230
Denial/Reject Explained  5,529
Appeals 501
General 2,471
Billing  1,594

 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:

  • Enter data via the Interactive Voice Response (IVR) telephone system
  • Submit claim status inquiries via the Palmetto GBA eServices Internet-based portal
  • Query claim status via Direct Data Entry (DDE)
  • Send a Health Care Claim Status Request (276 transaction) electronically and receive a Health Care Claim Status Response (277 transaction) back from Medicare

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

JJ Part A

JM HHH

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 

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