Provider Contact Center (PCC) Frequently Asked Questions (FAQs): January 2019 - March 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 January 1, 2019, through March 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 5,464
  • Financial 1,401
  • Denials/Rejects 5,899
  • Appeals 1,168
  • General 3,434
  • Billing 1,733

  • RTP/Status 6,269
  • Financial 1,940
  • Denials 7,882
  • Appeals 1,238
  • General 2,641
  • Billing 3,112

FAQs Related to Highest Inquiry Categories:

Question: If an adjustment claim edits for the reason code 30928, how long must the original claim stay in this status/location before it moves to the next location?

Answer: If an adjustment claim edits with the Medicare Secondary Payer (MSP) Reason Code 30928, the original claim must remain in status location B7516 for 75 days before the adjustment claim can be processed.

Question: How much time do I have to respond to a Provider Enrollment Revalidation request? 

Answer: Providers have 60 days from the date of the revalidation notice to submit their complete enrollment information. Providers are to submit their CMS-855 revalidation enrollment applications only after receiving notification that they are required to do so. Please refer to the Revalidation Due Date Lookup Tool.

Question: If the provider has an eServices account, who will receive the Additional Documentation Request (ADR) letter when the eDelivery option has been selected? 

Answer: Your administrator will receive the ADR letter via eDelivery. Additional information is available in the Palmetto GBA eServices User Manual (PDF, 7.88 MB).

Question: What condition code should be used to report when a patient has multiple medical visits occur on the same date in the same revenue center, but the visits were distinct and independent visits?

  • RTP/Status 4,034
  • Financial 3,316
  • Denials 7,892
  • Appeals 706
  • General 2,322
  • Billing 1,637

FAQs Related to Highest Inquiry Categories:

How does a hospice provider correct an erroneous election date on a Notice of Election (NOE)?

Answer: To correct an election date previously submitted in error, enter Occurrence Code (OC) 56 and the election date reported on the original NOE. The “Admission” Date, “From” Date and Occurrence Code 27 date are submitted with the correct dates. When Occurrence Code 56 is submitted on the NOE, Condition Code D0 (zero) must also be entered. If both codes are not on the NOE, it will be returned to the provider. Please refer to the Notice of Election (NOE - TOB 8XA) Billing Job Aid.

Question: What MLN Matters article gives hospice billing information to correct an erroneous revocation date?

Answer: SE18007 Recent and Upcoming Improvements In Hospice Billing and Claims Processing (PDF, 82 KB)was revised on August 20, 2018, to amend the process for removing a revocation date submitted in error.

Question: What hospice change request states revenue code 0659, HCPCS A9270, and modifier GY is needed to receive a line denial for room and board charges?

Answer: You may refer to Change Request 7677 (PDF, 227 KB) New Hospice Condition Code for Out of Service Area Discharges. Further information is available in the Billing for Denial of Hospice Room and Board Charges Job Aid.

Question: When did the Medicare Provider Enrollment Moratoria expire?

Answer: As of January 30, 2019, there are no active Medicare Provider Enrollment Moratoria in any state or U.S. territories.

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