End of the Month/Quarter Provider Inquiries

As we enter into the last days of the month and quarter, many providers work to clean up their accounts receivable and other unresolved tasks. This often generates a sudden and higher than normal provider call volume to the provider contact center.

In order to best serve the provider community, Palmetto GBA recommends providers consider the following actions before calling the provider call center:

• Review your Medicare Remittance Advice (RA) for the denied/rejected claims and identify the claim adjustment reason and remark codes. These codes are located on the last page of your Palmetto GBA RA and will define the reason(s) for rejections and denials and will indicate if a claim has been afforded appeal rights.
  
  
  • Use the Reason/Remark Code Lookup Tool and the JJ Part B Denial Resolution Tool or the JM Part B Denial Resolution Tool for more help with denials and rejections
    
• Consider using the Palmetto GBA eServices secure portal for claim status and duplicate copies of remittance advice
  
• Check the status of your redeterminations (first level appeals) submitted by mail or fax using Palmetto GBA’s Jurisdiction J and M Redetermination Status Tool. If you submitted your reopening or redetermination through eServices, check the status through Palmetto GBA eServices tool. The Palmetto GBA eServices User Manual (PDF, 7.85 MB) can answer questions and guide you through the eServices portal.
  
• Check the status of your provider enrollment application using Palmetto GBA’s Provider Enrollment Application Status Tool
  
  
  • Jurisdiction J Provider Enrollment Application Status Lookup Tool
  • Jurisdiction M Provider Enrollment Application Status Lookup Tool
    
• CMS requires providers use the Palmetto GBA Interactive Voice Response System (IVR) for claim status and eligibility inquiries. Use the Jurisdiction J IVR tools or Jurisdiction M IVR tools to help you navigate the IVR.
  
• All Palmetto GBA forms and links to CMS enrollment forms can be found on the Palmetto GBA website
  
  
  • Palmetto GBA Jurisdiction J Medicare Forms
  • Palmetto GBA Jurisdiction M Medicare Forms
    
• If you do call the provider contact center, be sure to have the following information ready at the time you place the call:
  
• PTAN, NPI and last five digits of your tax identification number 
• Beneficiary's full name as it appears on their Medicare card
• Medicare Beneficiary Identifier (MBI/HIC)
• Any other information or examples needed to discuss your question, claim or situation