We are in Sacramento, does anyone have a name of an attny we can contact. Haven't been paid since Jan.

I have spoken to an attorney friend about legal action against Palmetto for many of the reasons mentioned all over a simple change of address. He directed me to the internet sites upset with them. I would like to see a class action suite and would be more than happy to participate. Our Congressman is Kevin McCarthy, 22nd District, Bakersfield, CA. Their office says "they are being investigated"... but action? results? -let alone what compensation for nearly two years no lack of payment. If it wasn't for pay cuts and loans up to the neck we would never have survived. Any legal actions, class actions or other, I'm here!

Hi all- I strongly recommend attending the Palmetto spring conferences that review the enrollment process and addresses general concerns and issues on payments, denied claims, etc..Check Palmetto's web site to see the various conferences in Northern California.

I represent a provider who has reached the end of the line with Palmetto and its improper handling of claims with the apparent deliberate purpose to deny clean and appropriate claims. Please e-mail me with any insight you can offer to add to the formidable case we have. Absent a sudden change, there is going to be some very public scrutiny and accountability for Palmetto's conduct.

It took me 1 yr to obtain a provider number and another year to link it up to a billing submitter number. Yesterday, I received a letter from Palmetto notifying me that my provider number will be deactivated for not billing withing the past 12 months. Not sure where to go from here. Two years of providing services and not collecting one single penny.

I have been billing Medicare for a little over 3 years now. My biggest suggestion to all providers is APPEAL APPEAL APPEAL I do not even waste my time calling customer service since Palmetto took over all they do is read your denial back to you and tell you to appeal. Send it certified! If you redetermination and reconsideration get denied take it to the judge with and ALJ EVERY appeal I have sent to the ALJ for our hospital has been paid!

Wake up people CMS is pulling all strings and makes all policy and decisions.They are the evile empire and do not care about beneficiaries or providers.Palmetto and NHIC are just two different wolfs in sheeps clothing. We need to make all law makers have medicaid and medicare insurance (Senators/Congressmen). Then and only then will these two carriers be cleaned up. Providers are the fall guys here, not the patients and not the tax payors

Palmetto is a major joke. In my own practice, i do my own claims billing. The other few insurances that I work with are excellent with their claims reimbursement. I have not been paid for three months for one Medicare patient; and by the way, I do not plan to take any future Medicare patients into my psychotherapy practice.

CMS is doing a survey on Palmetto. I think that CMS need hear from us about how upset we are about Palmetto. The link for the survey is www.cms.hhs.gov/MCPSS/Downloads/2010_MCPSS_contractor_survey.pdf.

I read your article and have found myself in a potential situation where I will have lost approximately $20000.00 or more due to a timely filing situation. You see we did everything right and yes we got confimation claims (from the clearinghouse)that all was forwarded to the apppropriate insurance payor as all was processed clean etc.from the clearinghouse. The problem is the clearinghouse doesn't submit claims until the next day (even though they state they do when they process the claim that day )but the transmission was 3 days later.Im curious as to does this happen often and if so what have these damaged providers done and have they been succesful in recouping there loss from the clearinghouse. Doesn't the clearinghouse have a responsibility to file claims if they state they have done it.(ie they state the claims 'have been forwarded to' telling me that they have done the action of forwarding them." Im curious to know the responsibility of the clearinghouse. By the way the claims could of been sent even 1 to 2 days later and would have been ok (accepted) but 3 days late was to late. They may claim software problems but there wasn't and no correspondance was sent to us stating any problem.

FOR CODES 91132 AND 91133 EXCEL FILE VS. PDF FILE DO NOT MATCH!!!!! TC & 26 do not = global rates on the palmetto website There are also 8 codes that need the # sign to be on the lower amount in the Excel File 21800 21820 23520 23570 27193 27200 27246 27767 What a pain, I've been trying to contact palmetto and I'm not getting any where with them

Palmetto has been having system problems since 12/24/09 and then they are going to stop issueing checks from 01/01/2010 to 01/15/2010. Palmetto is a joke...bring back NHIC

I was fighting Palmetto for over 10 months to get paid for work done as long as 2 years ago. I finally gave up on the Provider line, voicemails to Finance, etc. None of that gets you anywhere. I wrote an angry email to their top brass (http://www.palmettogba.com/palmetto/AboutArea.nsf/officers.htm), and threatened them with litigation. I got a breathless call from Palmetto the very next morning and 48 hours later, the money arrived. Play hardball with these people; its the only language they understand.

i would like to know if we are enrolling for a provider, and the corporation owner is non physician and is not providing service to the patient, he would me a director but there is a doctor who will provide service what forms should we fill out

Hi Guys, I am working for a Nothern california based Rheumatology specialist and our Provider Profile with Medicare got deactivated we had a new PTAN issue (indivitual) but we billed with the group PTAN and Indivitual PTAN upto now. how should we bill once the changeis done?

FIND OUT WHO YOUR LOCAL CONGRESSMAN IS AND CALL HIM !!! I wouldn’t be here today if I didn’t call my rep. They all know about Palmetto. They have the pull and connections to get things moving. DONT EVEN QUESTION THIS, THAT’S WHY THEY ARE THERE. FOR THE PEOPLE... USE THEM THEY ARE MORE THAN HAPPY TO HELP. CALL YOUR LOCAL DISTRICTS CONGRESSMAN ONE MORE THING, STAND UP FOR YOURSELF, GET MAD AND TAKE ACTION!!! WE THE PROVIDERS DID NOTHING WRONG HERE YET PALMETTO TRIES TO MAKE IT SEEM THAT WAY. SO PLEASE TAKE ACTION AND CALL, CALL EVERYBODY THAT WILL LISTEN. YOU HAVE THE WHOLE INTERNET AT YOUR FINGERTIPS!! USE IT AND STAND UP!! CALL YOUR LOCAL DISTRICTS CONGRESSMAN I HOPE THAT YOU FOUND THIS HELPFULL. GOOD LUCK AND TRY TO STAY POSITIVE. ROBERT

I spent over one year getting a PTAN number, actually a reactivation of my number. This process included two separate application forms, twenty or more calls, and only resolved after demanding to speak to a supervisor and waiting over thirty minutes . They then refused to pay my claims older than than six months, even though I was assured they would when I started the process. Now I cannot get paid as they kick back my claims for all kinds of changing reasons. The last one was it was too light or too dark on some area of the form, even though the form looks fine to me. They are impossible to deal with in a rational way. If I ran my practice this way I would be out of business.

If you need assistance becoming credentialed with Medicare, making changes to your Medicare file, or simply re-validating your file with Medicare, there are companies who can assist you. If you would like more information, please call me at: Yvette Leal (530)329-8490

First I just need to change the address after long long long process it was back that provider need to re-validate,anybody I need help on the re-validating (????) so it wont get rejected. My provider was delayed on the payment for 3months already and this provider enrollemen Marylyn is so rude not willing to help on the application, she said she cant stay on the for long time coz she has to pick up the other line. This palmetto is worse than HMO Medicare switch back NHIC please please this Palmetto is so worthless and not knowledgeable to give info to the provider

WHY IS IT THAT WE GET PAID FOR PROCEDURE CODES ONE MONTH AND THEN HAVE THE SAME CODE WITH THE SAME DIAGNOSIS DENIED THE FOLLOWING MONTH??

What is CMS is thinking? September will be a year that Palmetto has the contact and the problem has not be resolved. Claims are denial in error, lost of payments, many provider have left the Medicare, providers are refuse to take Medicare patients, many small providers have gone out of business and other are on the verge of going out business, providers planning or done a class suite against Palmetto, (a year later Palmetto blamed NHIC for the problem) my question to CMS is 4 years of this? Is it CMS purpose to be sure all providers going out of business. Maybe President Obama need to look close at CMS. CMS owe Provider, Medicare patients, President Obama explanation why they kept Palmetto.

Palmetto's systematic denial of payment of properly processed Medicare claims is fraudulent business practice and is doing great and irreversible harm to California's medical services. Many small providers have already been driven out of business and many others are on the verge of closing. All affected parties should join in a class-action suit filed against Palmetto seeking reimbursement of all damages.

we are having a nighmare with PGBA most of the last year claims were denied by PGBA as Duplicates but no proper information on the original claims processed. Most of the time the customer service not helpful, manage to talk to the next level still no use. They simply tell us to wait for some more days as they have sent claims back for precessing ( almost got the same information 5 times). DO you know anyone in PGBA where we can straignten up these issues PLEASE HELP!!!!!!!1

FINALLY AFTER 10 MONTHS OF WAITING AND DEALING WITH PGBA J1 PROVIDER UNIT I RECEIVED OUR PTAN, THRU THE HELP OF OUR REGIONAL CMS OFFICE.I CONTACTED THEM LAST JULY 1,2009 AFTER 14 DAYS A GOT A PTAN AND I ALREADY SENT MY 1ST CLAIMS TODAY AND IT WAS RECEIVED WITHOUT A PROBLEM. PLEASE CONTACT YOUR REGIONAL CMS FOR HELP.....THANKS.

PTAN is your provider transaction number, this number is assign to you by Medicare once your application is approved. In SC group ptan's usually start with a "W". You can get a ptan if you apply to become a Medicare provider.

90% of my claims for the last 2 months have been denied for no stated reason. If this continues, I'll have to close my practice and lay off approximately 8 people. At least 200 patients will no longer get the physical therapy they've been getting, and another 50 patients will no longer get the Internal Medicine care they've previously been getting. It takes money to pay staff and rent, even if I don't get paid at all myself. Palmetto's current blanket denials may well put me out of business. I've spent countless hours printing my previous hand-written notes, resubmitted them, and have AGAIN had them rejected. On the 2nd rejection, Palmetto claims that my "signature" is not appropriate, and that they cannot identify the provider of services. This is a specious claim, given that I have not only signed my notes, but stamped my printed name as well. It would appear Palmetto is deliberately denying claims for no reason whatsoever, in order to reduce outlays. For the record, these new denials follow the 8-month initial no-payment period where I was not paid while I waited for Palmetto to approve my numbers. (i.e., after only 3 months of paying my claims after the 8-month delay, Palmetto is AGAIN denying my claims. Are any other doctors out there having this kind of trouble?

Does anyone know what a PTAN# is or where to get one?

Can anyone suggest a biller/billers who are aware of all the palmetto snags? I have some cases that were denied I want to contest. No one localy is able to help. Thanks. Carol Coal, LCSW Eureka Calif

Over a year ago I received a form that our Pathologist needed to have paperwork completed to revalidation with PGBA. I sent in an 855I and an 855R and it was returned to me stating they needed more information. I submitted the correct information and never heard from them for 60 days. I called at least 6 times asking for the status of the application. They kept telling me the forms were all correct, but they were experiencing a backlog. I called again in 30 days and was told that "I will hand carry this to Josh's office to have him expedite this form". I called again and the person thought she had put me on hold, but didn't. She was speaking with her coworkers who were having a personal conversation. She told them that I had been waiting 6 months for my provider application to be processed. They all laughed and joked about it being done when they get ready to do it. "We can only do so much and we are understaffed to do all this work". They never came back on the line and after 15 minutes, the phone just went dead. I called back in a week and got a wonderful girl by the name of Gina who spent l hr and 15 mins with me on the phone. I told her I would not stop until I spoke to a Supervisor and got this taken care of today. She worked on the application, then took it to a "Lead". They looked at the application and saw one area that needed to be changed. She said to fix this and resubmit the forms again and they should go through this time. However, I will have to do an appeal to get all of my old claims paid. She said they may go back only 30 days. We have a huge backlog, so I will be fighting this one. I never had this problem with NHIC. They were always helpful and walked me through new applications to make sure everything was correct. PGBA has a poor attitude and I really don't think they know what they are doing. We want NHIC back.

We too have not been paid by Palmetto since Feb 2008. I contacted my congressman today and am consulting with an attorney. I saw the post for the VP of Palmetto. Will give that a try as well. Don't forget we are also owed interest on that money. Will advise once I have resolution.

I have been trying to explain to anyone who will listen that our Pathology professional charges (modifier 26)are being denied with CO-04 which states "The procedure code is inconsistent with the modifier used or a required modifier is missing". This is the only way we can bill since we are only doing the interpretation. We know this is a non-payable charge with Medicare but is payable by Medi-Cal when rejected/denied with the correct code. Is anyone else having this problem?

Could you kindly give me details as to who I need to contact to enroll dentist in CA medicare part b for fee for service. THank you, BIna

Suffice to say, I, too, have thousands of dollars in fees out there, waiting, like planes over O'hare, to land. I have been trying to re-enroll for 14 months! Nine months into the process I was told my number was okay and so I started seeing MediCare patients, but then my billing was refused because they said I didn't have a valid number! And thus begins the descent into bureaucratic hell. You all know the phone maze, the mind-numbing wait, the wrong information over and over and the promises that it's going to be taken care of this time. You've heard of the three promises? The check's in the mail, I'm not married and I'm from the government and I'm here to help you. Well, that's really, "I'm from Palmetto GBA and I'm here to help you." I left a message for the medical director of Palmetto GBA, Arthur Lurvey and I'm going to email him with my saga. His info is contained in the post from Jan 10, 2009 :The Palmetto Nightmare. Why did they have to change to Palmetto anyway? I'm guessing less expensive.

Since Palmetto took over Medicare claims processing our office has had to deal with dozens of ridiculous denials - stating the legacy number was on the claim when clearly it wasn't, calling specific codes nonspecific, etc. The Medicare site has tons of information about filing a complaint against your doctor but virtually nothing to help with filing a complaint against Medicare. I've been instructed to contact Consumer Protection & I suggest others do so also.

IF YOU WANT TO TALK TO A LIVE PERSON IN PALMETTO, CALL 877-527-6594. IT'S IN THE INTERNET, SO I DON'T THINK I'M DOING ANYTHING WRONG IN PASSING IT ON. GOOD LUCK

I found your website with comments about Palmetto. It is not only family physicians that are finding Palmetto a disaster. I notified them of an overpayment because their form reader mis-read a procedure code which was not my mistake. My mistake was to notify them of the problem. I informed them what I should have been paid, what they paid me, etc. using their forms and their instructions but then they sent a bill without any documentation or explanation for over double what I owed them. Today, after at least 15 telephone calls over two months (I am a sole proprietor and handle my own billing), one of their employees had the audacity to tell me that I had to pay them whatever they told me I had to. Otherwise they would not pay any of my claims. But if I do not inform them of overpayments due to their errors, they can come back at me for the overpayment, charge me for interest for all the time before they discover it and even allege fraud. It is still not resolved--I finally was told to call the Finance/Accounting department, a telephone number someone told me was the one I should have been given two months ago (the fourth of many telephone numbers I was given to resolve the problem) and told to leave a message--no person to talk with, nothing. A real disaster. I am going to speak with my congressman as I saw that your organization has done. Something has to change soon. Thanks

I agree.Palmetto is a disaster. Please read the article in the Sacramento Business Journal Friday, January 21, 2009. In that article, I was quoted. I have 3109 claims outstanding and I am owed a tremendous amount, in the hundreds of thousands. We need to band together and do something.

Dear Nevada, I e-mailed ALLISON.MCLEOD@Palmettogba.com, copy to PERRY.MATTOX@Palmettogba.com and actually got a very nice answer. This is the J1 Congressional Unit. They were't too helpful, because I don't think they fully understand the claim intricacies, nor do the claim representatives or the claim processors. However, I gave claim names and Medicare ID numbers for claims that have not been paid since Dec. 2007, the physician NPI, PTAN, and since it will be required beginning March 1, 2009, the physician Tax ID number or TIN. This unit did not find any payment of claims for the physician going back to 2006--of course not, he does not accept assignment, so the payment of claims goes to the Medicare beneficiary; nor did they find any pending claims (there are 3 at the present time). So, for what it's worth, give the Congressional unit a try.

Thank you to oscar guzman for the tip on the "How are we doing?" area on the Palmetto site. We've been trying to just get re-enrolled for months. Suddenly when we wrote to J1MAC_Provider_Concerns@cms.hhs.gov they actually started returning phone calls and we got a fax with the info we've been waiting for. The people there are Neal Logue or Merle Corpuz. They must be federal Medicare employees trying to oversee Palmetto.

it has been almost one year and our office has not received any payment because the EDI department keeps blocking our application, we are also one physician and with no monies coming in our practice is suffering. Does anyone have any contact numbers to Medicare not the EDI department. Nevada

Many County Medical Associations have an Economic Advocacy Department available to their physician members. Physician members have free access to a trained Economic Advocate whom they can ask them how to resolve reimbursement problems. The county economic advocate, if necessary, can call the Palmetto liaison. As a result, physician members of county medical asscociations have been among those least affected by Palmetto delays.

I am a neuropsychologist in Northern California and am at my wit's end with Palmetto and their takeover of Medicare, which has been a nightmare! I have a growing stack of unpaid claims next to my desk and am wondering what I am going to do to pay my own bills. All of my attempts to contact Palmetto are either met with a busy signal; a request to leave a message which will never be returned; a surly operator; or someone who has no idea what's going on (did they outsource their system?). I have written letters to CMS and to the Medical Director of Palmetto in California. They did send me a small check and an apology, but now I am back to square one. Here is the information for contacting the Medical Director for Palmetto in California: Arthur Lurvey, MD Contractor Medical Director Palmetto GBA - J1 MAC Medical Review Part B PO Box 1476, Augusta, Georgia 30903-1476 Phone: (310)476-5760 Fax: (803)462-3918 E-mail: Arthur.Lurvey@PalmettoGBA.com I am always polite when I send him and email and tell him I will stop writing to him when his company starts paying me in a timely and reliable manner. I suggest others do the same. I have also called him and received a call in return. Dr. Nancy Hoffman PsyD

Working for a clearinghouse serving providers nationwide, I have personally seen many transitions. Perhaps some of these comments will help with regard to understanding some of the issues listed above. Typically when a new administrator takes over responsibility for claim processing, they receive "good provider demographics" from the old administrator. A certain small percentage of provider's data doesn't transfer correctly and these providers experience problems with claim processing. The new administrator may have received old/bad data or none at all. Typically, the provider must "sign up" again, somewhat as if he has never been contracted with Medicare. (This can take months with any Medicare administrator.) This process does not involve an electronic clearinghouse, but the next step does. The next step is to complete an electronic EDI enrollment form and submit it to the clearinghouse or directly to the Medicare administrator. (The clearinghouse will forward to the administrator.) Check with your clearinghouse to see if they have someone "tracking the paperwork" and checking regularly for an electronic submission approval from the administrator. Typically when EDI paperwork is submitted to us, we track it until a response (typically an approval to transmit claims) has been received. Unfortunately, this process normally takes yet another 30 days. We are seeing up to 90 days right now for California providers due to the shear volume of submissions. When the paperwork is not completed accurately, we receive a "reject" and the provider must make corrections, submit EDI enrollment paperwork again and wait yet again for an answer. Finally, when the approval has been received, the clearinghouse can start forwarding claims to the Medicare administrator. Once the electronic link approval has been received and claims submitted, we have had great success receiving reports showing claims accepted. Our biggest stumbling blocks are when providers do not complete the EDI enrollment forms accurately resulting in a rejection and when providers do not have billers or a billing service that understands the process of enrollment. Sadly, some providers do not understand how important it is to have an informed biller or billing service handle their needs. Exceptional, experienced billers make it look easy. It's not easy and experience counts. Proper billing & viewing of reports is a process. Simply submitting the claim and not viewing reports (payor responses, aging, clearinghouse reports)will only result in reduced revenue and missed claim filing deadlines. DISCLOSURE: The clearinghouse that employs me is not aware of and did not authorize this posting so I am unable to disclose the name of my employer. Should you wish to communicate with me personally, please contact the web administrator. Hopefully they can forward your email to me for a reply.

I feel like we're drowning in a sea of incompetent, surly, personnel when it's only money our beneficiaries and/or physicians are trying to obtain for a valid claim, for a valid reason, for the premiums they pay not only for Medicare, but the Medigap premium; but some glitch within Palmetto prevents any sensible reason for not paying. I wrote the Office of Inspector General, Human Health Services, HHSTIPS, PO Box 23489, Washington, DC 20026, phone 800 447 8477; also Medicare Coordinator of Benefits Contractor, Centers for Medicare and Medicaid Services, 7500 Security Blvd., Baltimore, MD 21244-1850; and Medicare Beneficiary Contact Center, PO Box 39, Lawrence, Ks 66044

In answer to the denial reasons, oa-109 means pt is enrolled with a medicare hmo, you can get the name of the hmo through calling the ivr 18669313903 just follow the prompts, and the co-50 means the diagnosis is not payable per the LCD (local coverage determination) which can be found on the cms web site. Hope this helps.

I have 17 claims outstanding since the transition to Palmetto GBA 9/2/08. Each time I call the Provider line, there is a different reason why the claims were not paid. After waiting an hour for an answer, this is just sad. I was told by one representative that he was going to repeat the answer one more time. There is a claim dating back to December 2007 with two office visits unpaid. Over the period from December 2007 to November 2008, there have been 5 different reasons for not paying the claim: Not eligible for Medicare, missing/incomplete/invalid information on where the services were furnished; Missing/incomplete/invalid billing provider/supplier primary identifier; Missing/incomplete/invalid rendering provider primary identifier; Provider needs to update his enrollment records. Prior to Dec. 2007, this beneficiary's claims were paid without question from 1/10/07 to 11/14/07; they were subsequently paid for service from 1/09/08 up to 8/06/08 without question. So why is this happening? Is Palmetto GBA out of money before they even start?

CAN ANYONE HELP ME WITH THE DENIAL REASON CODE (OA-109) AND ALSO CO-50 WHAT DOSE IT MEAN NOT DEEMED A "MEDICAL NECESSITY" I TRIED TO CALL FOR HELP BUT NEVER GET THROUGH TO ANY LINE AND TAKES LONG... DONT HAVE THAT KIND OF TIME TO JUST SIT ON THE PHONE TO GET NOTHING ANSWERED?

Once Palmetto took over, my life became a living hell. I do all my own billing and have for many years, and with few problems or issues with over 18 insurance companies. Finally though, I found someone, but only by writing to the person listed on the "How are we doing?" area on the Palmetto site - it went to the CEO and then someone contacted me and I got paid. Not sure what will happen next, but they gave me a contact person who was helpful. Maybe that could help some of you too, write the CEO!!!!!!

I heard Palmetto GBA is being sued by Physicians for lack of payment . Does anybody know if there is a lawyer doing this in San Diego?

This is the most outragious experience I have had with Medicare. All the numbers never answer, no responce to E-mails or letters. What does it take to get support from this company.