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.
© 2019 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
Issue Identified: On Going
Issue: Palmetto GBA is experiencing a high volume of pending workload for claims that require clinical review.
The list below includes examples of claim types that may be affected; however, the list is not all inclusive.
Provider Action: No provider action is necessary at this time and there is no need to contact the Provider Contact Center. Palmetto GBA has implemented a plan and is currently working to reduce the pending claims volume for these claims. The CPIL will be updated as new information is available.
Financial Hardship: Providers that have more than 100 claims pending that meet the criteria listed above and the delay is creating a financial hardship may call the Provider Contact Center with the internal control numbers (ICNs) of the affected claim and request the claims be expedited. Providers should not include any claims that have been pending after claim submission for less than 30 days and requests must meet the 100 claim minimum and/or financial hardship.
12/6/2018 Resolved: Jurisdiction J and M medical review workloads have been reduced to within the normal workload ranges.
10/26/2018: Palmetto GBA continues to work through the pending workload requiring medical review. Requests representing a provider financial hardship and meeting the criteria for the expedited requests outlined in this CPIL are completed in the order they are received.
9/20/2018: Palmetto GBA continues to reduce the pending workload and expedite those inquiries that are brought forward representing a provider financial hardship and meeting the other criteria for expedited requests outlined in this CPIL.
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: 12/06/2018