Palmetto has provided CMA with the following additional information on previously held June claims:
· Palmetto began processing June claims with the 2.2% increase on Thursday, July 1.
· Claims with June dates of service received on June 1 and June 2 that were subjected to the 21% reduction are being adjusted up to the new fee schedule (or submitted charge, whichever is less), and physicians can expect to start seeing those corrected claim payments next week.
· Claims submitted at the previous fee schedule amount will not be automatically adjusted. Once physicians receive payment for these claims, they will have to submit corrections to the submitted charge to the written reopening post office box (see last bullet). Palmetto also asks that physicians who received payment at the 21% reduction amount wait until the corrected claims are received before they request a reopening to increase the submitted charge.
· Palmetto is releasing held claims a day or two at a time, with the oldest claims being processed first. The volume released is dependent on incoming claim volume and national system capacity for processing claims. Daily calls are being held with CMS to determine how much can be released. As of July 7, Palmetto has processed claims received up through June 8 or 9. It takes approximately 2-3 days from release into the processing system before a check or electronic payment is generated. Palmetto is hopeful that all the held claims will be released within the next two weeks.
· Palmetto is still working on formatting the new fee schedule with the 2.2% increase for posting to their website. They expect to have it posted by July 15 or sooner.
· Some physicians continued to submit claims at the fee schedule amounts that were in effect from January through May. Palmetto GBA cannot automatically adjust these claims. Physicians will have to submit corrections to the written reopening post office box (see address below). Physicians may request an adjustment to the billed charge by submitting a spread sheet indicating the procedure code, the corrected submitted charge, the ICN (claim number) of the claim and the paid date. They can also submit the EOB’s and include a list of the procedure codes with the corrected billed charge. Physicians should use the reopening form from Palmetto’s website. Requests for reopening should be sent to: Palmetto GBA, Part B J1 MAC, P.O. Box 1252 Augusta, GA 30903-1252
Contact: CMA’s member service center, 800/786-4CMA or memberservice@cmanet.org
Last Updated Wednesday, July 07, 2010 - 07:28 PM.
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