Quarterly Frequently Asked Questions (FAQs): November 2018

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

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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