Full Answer
What does GBA stand for in insurance?
Group Benefits Associate—GBA The Group Benefits Associate (GBA) designation is an ideal fit for those dealing with health and other group benefits. The courses reflect up-to-date and relevant information needed to effectively design, administer and communicate group benefits.
How do I earn the GBA and CEBS designation?
To earn the GBA designation, you’ll need to complete the following three courses. If you’re working on the CEBS designation, all three of these courses apply toward the CEBS five-course requirement.
How do Part B providers bill Medicare?
Part B Providers (Physicians, Practitioners, and Suppliers) Gather accurate MSP data. Determine if Medicare is the primary payer by asking patients or their representative(s) for MSP information. Bill primary payer before billing Medicare. Submit an Explanation of Benefits (EOB) or remittance advice from the primary payer with all MSP information.
What happens if a GHP is not billed to Medicare first?
If there’s a primary GHP and the provider doesn’t bill the GHP first, Medicare will not pay conditionally on the liability (including self-insurance), no-fault, or WC claim. Providers must bill the GHP before billing Medicare, and the primary payer payment information that appears on all primary payer remittance advices
Is Palmetto GBA the same as Medicare?
Palmetto GBA is the Railroad Retirement Board Specialty Medicare Administrative Contactor (RRB SMAC). We process Part B fee-for-service claims for Railroad Medicare beneficiaries nationwide.
What is Palmetto GBA eServices?
Palmetto GBA's eServices is a free, internet-based, provider self-service secure application. Palmetto GBA's goal is to give the provider secure and fast access to their Medicare information seamlessly via our website through the eServices application.
Who owns Palmetto Medicare?
the Celerian GroupPalmetto GBA is part of the Celerian Group, a consortium of companies that helps government and private health care plans navigate the complexities of benefits administration.
How do I contact Palmetto GBA?
For inquiries regarding provider enrollment, please call the Provider Contact Center at 855–696–0705. For education, please complete the Education Request form. To access this document, go to the Forms web page at www.PalmettoGBA.com/hhh/forms. Provider inquiries, please call 855–696–0705.
How do you bill Railroad Medicare electronically?
To start electronic billing, please visit the Electronic Data Interchange (EDI) portion of our website at www.PalmettoGBA.com/rr and download our Railroad Medicare EDI Enrollment Packet. Electronic Remittances can be requested by selecting the appropriate box on the Railroad Medicare Part B EDI application.
How do I verify eligibility for railroad Medicare?
Verifying Railroad Medicare enrollment is easy using our online PTAN Lookup and Request Tool. This tool first validates the provider identification information you enter — local Part B MAC PTAN, National Provider Identifier (NPI) and Tax Identification Number (TIN) — against enrollment information in our files.
What is a Mac for Medicare?
A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.
What is the difference between Medicare and Railroad Medicare?
A: The only difference is that retired railroad beneficiaries have their Part B benefits administered by the Palmetto GBA Railroad Retirement Board Specialty Medicare Administrative Contractor (RRB SMAC) regardless of where they live. Members should be certain to advise providers of this when they receive treatment.
What is Palmetto?
Definition of palmetto 1 : any of several usually low-growing fan-leaved palms especially : cabbage palmetto. 2 : strips of the leaf blade of a palmetto used in weaving.
What is Palmetto GBA Medicare payer ID?
PGBA previously used a Payer ID of 00380 to appear on electronic claim files submitted for processing. PGBA's new Payer ID of 11001 is required as of Monday, January 24, 2011.
Does Palmetto GBA accept paper claims?
Claims may be filed to Palmetto GBA electronically (this applies to most Medicare providers) or on paper (if certain conditions or exceptions exist).
Is Palmetto GBA a fiscal intermediary?
Palmetto GBA is the fiscal intermediary for Part A Medicare Administrative Contractor.
When did CMS standardize reason codes?
In 2015 CMS began to standardize the reason codes and statements for certain services. As a result, providers experience more continuity and claim denials are easier to understand.
What does CMS review?
CMS contractors medically review some claims (and prior authorizations) to ensure that payment is billed (or authorization requested) only for services that meet all Medicare rules.
Why does Medicare make a conditional payment?
Medicare may make pending case conditional payments to avoid imposing a financial hardship on you and the patient while awaiting a contested case decision.
What is a COB in health insurance?
Coordination of Benefits (COB) allows plans to determine their payment responsibilities. The BCRC collects, manages, and uploads information to the Common Working File (CWF) about patients’ other health insurance coverage. Providers, physicians, and other suppliers must collect accurate MSP patient information to ensure that claims are filed properly.
What is Medicare Secondary Payer?
The Medicare Secondary Payer (MSP) provisions protect the Medicare Trust Fund from making payments when another entity has the responsibility of paying first. Any entity providing items and services to Medicare patients must determine if Medicare is the primary payer. This booklet gives an overview of the MSP provisions and explains your responsibilities in detail.
Can Medicare make a payment?
Medicare can’t make payment when payment “has been made or can reasonably be expected to be made” under liability insurance (including self-insurance), no-fault insurance, or a WC law or plan of the United States, called a primary plan.
Can Medicare deny a claim?
Medicare may mistakenly pay a claim as primary if it meets all billing requirements, including coverage and medical necessity guidelines . However, if the patient’s CWF MSP record shows another insurer should pay primary to Medicare, we deny the claim.
What is Medicare claim processing manual?
The Medicare Claims Processing Manual (Internet-Only Manual [IOM] Pub. 100-04) includes instructions on claim submission. Chapter 1 includes general billing requirements for various health care professionals and suppliers. Other chapters offer claims submission information specific to a health care professional or supplier type. Once in IOM Pub. 100-04, look for a chapter(s) applicable to your health care professional or supplier type and then search within the chapter for claims submission guidelines. For example, Chapter 20 is the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).
What is MSP in Medicare?
MSP provisions apply to situations when Medicare isn’t the patient’s primary health insurance coverage.MSP provisions ensure Medicare doesn’t pay for services and items that pertain to other health insurance or coverage that’s primarily responsible for paying. For more information, refer to the Medicare Secondary Payer