EDI Claims Electronic Submission

EDI Claims Electronic Submission (Palmetto GBA Guidelines)

EDI Claims Electronic Submission is released via telephone lines, via a modem, to Palmetto GBA. EDI Claims Electronic Submission gives the provider control over the timeliness and accuracy of the claims entry by eliminating the need for mailroom processing and manual data entry by Palmetto GBA.

  • Payment for ‘clean claims’ may be released by Palmetto GBA as soon as the Centers for Medicare & Medicaid Services (CMS) timeframe requirements for claims payment have been satisfied. The payment floor (minimum amount of time, required by law, for which all Medicare carriers must hold payment) is 14 days for electronic claims, as opposed to 29 days for paper claims.
  • Submitting claims electronically will result in an overall cost savings from not purchasing paper claims or paying for postage
  • For situations in which Palmetto GBA requires additional supporting documentation (e.g., requirements noted in a Local Coverage Determination or other publication), you may fax supporting documentation with your electronic claim. Refer to the section titled ‘Electronic Claims and FAX Attachments’ for more information.

Additional Benefits of Electronic Claim Submission: In addition to the day-to-day benefits of electronic claims submission, EDI senders may also take advantage of these other features.

  • Electronic Remittance Advice (ERA) – This feature allows you to receive paid and/or denied claims information electronically from the Medicare Part B system. ERA can be utilized to automatically update providers’ accounts receivable or patient billing system. ERA is equivalent to the Medicare Standard Provider Remittance (SPR) and can eliminate the need to post payments manually.
  • Electronic Funds Transfer (EFT) – Whether you are an electronic or paper sender, EFT provides the capability of electronically sending Medicare Part B payments directly to your financial institution.
  • Eligibility Accesses – Participating providers who have their claims filed electronically have access to beneficiary eligibility files, via a vendor access. By giving you access to your patient’s Medicare eligibility file, you can determine whether the patient is eligible for Medicare benefits; has met his/her Medicare deductible; is enrolled in a health maintenance organization; or is entitled to Medicare under the Medicare Secondary Payer provision.

Leave a Reply

Your email address will not be published.

Post Navigation