plogo

© 2021 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.

Published Date:06/01/2016

Printed Date: 9/22/2015

URL: http://palmgba.com/marlowe/redesign6/article.html

FAQs

Find answers to frequently asked Medicare questions below. For help with eServices, view our eServices FAQs.

After I receive a 277CA will I receive anything else?

Answer:
If you receive a 277CA, you will not receive another EDI report.

This was last updated on 12/15/2020

Back to Top

How can I check on the status of my Railroad EDI Enrollment Form?

Answer:
Please use the Railroad Medicare EDI Request for Enrollment Status Form. If you have a question about your status or do not receive a response about your status, please contact the EDI Provider Contact Center at 888-355-9165 to verify EDI enrollment.

This was last updated on 12/15/2020

Back to Top

How do I restore a remit file?

A remittance file can be restored to your mailbox by submitting an Online ERA/ERN and GPNet Report Restore Form. You will receive a request confirmation by email. The remittance files are available 20 business days prior to current date. You may also contact our EDI Provider contact Center at 855-696-0705 (JM), 877-567-7271 (JJ) or 888-355-9165 (RR) for assistance with restoring your file.

Please have your Submitter/Receiver ID, Dates to Restore, Check/EFT number, Check/EFT Amount, Email Address and Contact Phone Number ready before submitting a request. Palmetto GBA can only restore remit files for a submitter or if receiving files from a clearinghouse, the contact on file with EDI.

This was last updated on 12/15/2020

Back to Top

Is the 277CA returned for each test submission?

Answer:
You will receive a 277CA after you receive an approved 999.

This was last updated on 12/15/2020

Back to Top

Once I enroll for electronic billing, do I automatically receive electronic remits?

Answer:
No. Electronic Remittances can be requested by selecting the appropriate box on the Railroad Medicare Part B EDI application. The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Remittance Easy Print (MREP) software to enable Medicare providers to view and print 835 Electronic Remittance Advices. If you requested a receiver ID, you may click the download form for MREP Software to install. If you are using a clearinghouse/billing service to receive your electronic remittances, please contact the clearinghouse/billing service for assistance.

This was last updated on 12/15/2020

Back to Top

PC-ACE Pro32 software FAQs

What is Pro32 software and does it cost anything?
Answer:
The PC-ACE Pro32 software is a claims-entry software available from Palmetto GBA at no cost. It cannot be used in conjunction with any other software.

What do I need to do to utilize the Pro32 software? Where do I start?
Answer:
If you currently have a submitter ID, you can download the PC-ACE Pro32 software from our website under the EDI, Software & Manuals page for your contract.

Once I download the PC-ACE Pro32 software, is it an easy process?
Answer:
Yes. Please use the PC-ACE pro32 User’s Manual and the PC-ACE Pro32 Reference Guide along with the confirmation sheet you received. The PC-ACE Pro32 training modules are designed to address the basic information you will need to know to submit a claim electronically. You can view the PC-ACE Pro32 training modules from our website under the EDI, Software & Manuals page for your contract.

Do we have to manually enter each claim into the Pro32?
Answer:
Each claim must be manually entered. Pro32 cannot accept claims transferred from another software program. Please refer to the Pro32 user's manual, as well as Pro32 Training Module 3A (Part A claims) or 3B (Part B claims) for additional information.

This was last updated on 12/15/2020

Back to Top

What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance?

Answer:
Please have the following information available prior to calling about an EDI-related issue so we may assist you:

Provider Transaction Access Number (PTAN), also known as a provider number, or your National Provider Identifier (NPI)
Company name
Contact name
Telephone number
City and state
Submitter ID
File ID
Error Message

If you are unable to provide this information, you may be required to call back.

This was last updated on 12/15/2020

Back to Top

What is a Network Service Vendor?

Answer:
A Network Service Vendor provides high speed, secure connectivity to submitters for claim submission and responses. Please refer to a listing of CMS Approved NSVs (PDF, 63 KB).

This was last updated on 12/15/2020

Back to Top

What is an approved software vendor?

Answer:
An approved software vendor has completed and passed all 5010A1 or 5010A2 test requirements.

This was last updated on 12/15/2020

Back to Top

What is my Submitter ID?

Answer:
If you are new to Railroad Medicare, you will need to complete the RR EDI Enrollment Packet (PDF, 206 KB) to request a Submitter ID if you will be submitting claims directly to Palmetto GBA. If you are a provider and will be using a billing service or clearinghouse to submit your claims, you will not need a submitter ID. Vendors/trading partners will need to complete an RR EDI Application form (PDF, 98 KB) to request a vendor Submitter ID prior to testing. If you have forgotten your Submitter ID, please contact our EDI Provider Contact Center at 888-355-9165 for assistance.

This was last updated on 12/15/2020

Back to Top

What provider address should I include on the EDI enrollment forms?

The address on the EDI enrollment forms must match the address that was submitted to our provider enrollment department when enrolling for a provider number. If the address on the completed EDI enrollment form does not match, your entire EDI enrollment packet will be rejected.

This was last updated on 12/15/2020

Back to Top

What provider name should I include on the EDI enrollment forms?

The provider name must match the name submitted on the Medicare provider enrollment application.

This was last updated on 12/15/2020

Back to Top

What PTAN should I enter on the EDI enrollment forms if the provider is a member of a group?

The group PTAN (provider number) and group NPI must be submitted on all EDI enrollment forms when a provider is a member of a group. If a provider is a member of a group, only one agreement is required.

This was last updated on 12/15/2020

Back to Top

What Submitter Name should I enter on the Provider Authorization form?

Enter the name of the Submitter you are authorizing to submit and/or receive electronic data on your behalf. The Submitter Name must match the Submitter Name on the EDI Application.

This was last updated on 12/15/2020

Back to Top

When is a provider authorization form required?

Every provider who authorizes a billing service and/or clearinghouse to act on their behalf must complete the provider authorization form. This form must be completed by the provider and submitted with the EDI application.

This was last updated on 12/15/2020

Back to Top

Where can I locate the payer ID for Railroad Medicare?

Answer:
The payer ID for Railroad Medicare is published in the GPNet Communications Manual and Railroad Medicare PC-ACE Pro32 Reference Guide.

This was last updated on 12/15/2020

Back to Top

Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description?

Answer:
The STC segment will include the health care claim status. Please review the CEM 837 Institutional Edits (PDF, 2.43 MB) and CEM 837 Professional Edits (PDF, 2.22 MB) listings.

This was last updated on 12/15/2020

Back to Top

Will you reject claims with a P.O. Box in the billing provider address? Will you reject claims where the group number and policy number are the same values?

Answer:
Palmetto GBA will reject claims with a P.O. Box in the billing provider address. Effective October 1, 2012, the group number cannot be submitted.

This was last updated on 12/15/2020

Back to Top

How can I tell if I am set up for Electronic Billing?

Answer:
Please use the Railroad Medicare EDI Request for Enrollment Status Form. If you have a question about your status or do not receive a response about your status, please contact the EDI Provider Contact Center at 888-355-9165 to verify EDI enrollment.

This was last updated on 09/28/2020

Back to Top

Last Updated: 1/01/2021