Q. How do I get directly to the reopening line without having to speak to a Customer Service Advocate?

A. Calls to the reopening line are triaged by a Customer Service Advocate to ensure that a telephone reopening can be performed. Some requests require additional documentation or if a medically denied claim, the claim may not be reopened but will require the provider submit a redetermination (first level appeal).

Q. I have a dedicated Palmetto GBA analyst assigned to work my group’s enrollment and the analyst entered the incorrect information. Why can’t I contact my analyst directly instead of having an escalation completed and then wait 45 days for the information to be updated?

A. The Customer Service Advocate (CSA) will verify the information submitted on the application against what is entered on the enrollment record. If an error has been made, an escalation will be submitted for correction. Escalations are worked in the order in which they are received, and we work to resolve as quickly as possible.

Q. What should I do if Medicare and another insurance both pay a claim as primary?

A.  Refund the Medicare payment to Palmetto GBA within 60 days of the date you identify the overpayment, even if Medicare’s records show that Medicare is primary. Instructions for refunding Medicare Secondary Payments (MSP) can be found on the Palmetto GBA websites.

Q. Can I use the telephone reopening process to change a procedure code to a higher level procedure code?

A. When a provider is requesting a reopening to up code (change the submitted procedure code to a higher level of service) documentation will need to be submitted and this can not be done through the telephone reopening process. This request will need to be submitted in writing.

Q. Where can I purchase CMS-1500 claim forms?

A. You may purchase forms from one of the following offices:

U.S. Government Printing Office
Superintendent of Documents
Medicare Department
Washington, D.C. 20402
(202) 512-1530

Q. MolDx was implemented for Jurisdiction J on July 1, 2018. Is the date we are required to use the Z-Code based on the date of service or the date the claim is received by Medicare?

A. Any claim received on or after July 1, 2018, will require the Z-Code regardless of the date of service.

Q. When submitting required additional information for a claim, which fax cover sheet do I use?

A. The Claims Processing PWK Fax Cover Sheet is the correct form to submit for pending electronic claims requiring additional information for processing. You have seven days from the date of receipt of the claim to submit the documentation for processing.

Palmetto GBA encourages providers to submitted required claim documentation through the Palmetto GBA eServices portal. Select the 'Claims' tab then the 'Submit Additional Documentation' tab. The form is pre-populated with the information we know from your eService registration record. This will save you several steps. If either tab is grayed out, ask your practice's eServices Administrator to grant you access to these tabs. Full instructions are listed in the eServices User Guide (PDF, 7.69 MB).

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