Palmetto GBA E-mail Update: Thursday, October 15, 2015

Entering Beneficiary Information: Online Provider Services Eligibility Inquiry vs. Claim Submission
This article explains how to enter beneficiary information for each task: obtaining beneficiary eligibility from Online Provider Services and submitting a claim. Online Provider Services uses CMS’s HETS 270/271 system, as required by CMS, for all eligibility inquiries. To protect the privacy of beneficiary data, all fields entered, including optional fields, must match the beneficiary’s data as it is maintained by CMS’ HIPAA Eligibility Transaction System (HETS); otherwise, eligibility data will not be returned. Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

NEW! Contact List for Providers with Questions About Medicare and Medicaid
On October 1, the United States health care community transitioned to ICD-10. Recognizing that providers may still need help with the transition, CMS has issued a new ICD-10 Resource Guide and Contact List to help them find answers to their questions. CMS remains committed to working with the community on the transition. Help is available if you experience any challenges using ICD-10.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Name Change for Palmetto GBA’s Online Provider Services Coming Soon
Coming Soon: Palmetto GBA’s Online Provider Services will soon be changing its name. Providers will still be able to access all the same information within the portal. Be on the lookout for additional information on the website regarding Palmetto GBA’s online provider portal eServices. Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare
  • Online Provider Services//General Information

Local Coverage Determination (LCD) Update: Part A and Part B
Palmetto GBA has revised the JM A/B MAC LCD(s) titled Infliximab (Remicade) L35677. Please share with appropriate staff.

Applies to:

  • JM Part A//General
  • JM Part B//General

Local Coverage Determination (LCD) Updates Part B
The following JM Part B Local Coverage Determinations (LCD) was revised: Octreotide Acetate for Injectable Suspension (Sandostatin LAR) L33438. Please share with appropriate staff.

Applies to:

  • JM Part B//General

Claim Submission of Patient Information: Reminder
Effective February 18, 2015, providers began receiving claim rejections when the patient’s name and health insurance claim number submitted on a claim does not match the information on file for the patient. Many of these rejections are due to incorrect entry of the patient’s last name and/or suffix or incorrect placement of the patient’s name in the correct loops and segments of their electronic claim. Claims rejected will need to be corrected and resubmitted.

Applies to:

  • JM Part B//General
  • JM Part B//Physician
  • JM Part B//Primary Care

E/M Weekly Tip: New Patient Codes
Interpret the phrase ‘new patient’ to mean a patient who has not received any professional services (e.g., E/M service or other face-to-face service (e.g., surgical procedure)) from the physician or physician group practice (same physician specialty) within the previous three years.

Applies to:

  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

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