Health Care Policy

Palmetto GBA has been called upon to provide leadership and direction in developing national medical coverage policies for over 40 years. Our reputation for providing the highest level of technical efficiency in clinical services cannot be surpassed. Our team of over 140 medical review specialists set policy and billing guidelines as well as track trends in disease and health care across the nation. The physicians, nurses and technicians of Palmetto GBA have hundreds of years of medical expertise and remain on the cutting edge by utilizing the latest tools in our trade.

Along with a high volume of claims comes a high volume of data. Palmetto GBA data analysts are capable of mining data for a magnitude of variables. From epidemiological trends and over-utilization of services to misuse of the system or suspected fraud, our data analysts are able to detect patterns and areas of need down to the county or even a single provider with pinpoint accuracy. By automating much of our operation with the latest imagery technology, Palmetto GBA consistently processes the largest volume of medical information in almost half the time required.

Palmetto GBA also provides training to those who are new to the system and refreshers to those who are not. With over 40 years of experience, we are the company called upon to train medical professionals on how to navigate a complex health care system.

Our clinical team is at the forefront in our work with new classification systems like the International Classification of Functioning (ICF). Palmetto GBA processes almost 1.5 million claim reviews annually. We service more than 1.5 million providers annually. Almost $400 million has been detected and recovered via program integrity systems annually.

Along with our ability to identify training needs, Palmetto GBA is exceptional in our commitment to program integrity. Using professionals in the fields of law enforcement and investigation, we have identified and recovered hundreds of millions of dollars annually.

last updated on 12/07/2015