Wiki Palmetto denying PA claims

[HMJ]

Is anyone having problems with Palmetto not paying claims billed by PA? We've recently gone from Cigna to Palmetto as our MAC and they are denying inpatient & outpatient procedures billed by our PA's stating, "Medicare does not pay for this service when performed by a provider of this type."
Any help would be greatly appreciated.

 

[mitchellde]

There are some procedures that Medicare puts restrictions on as to the level of the provider, such as PA or NP or MD. you should be able to get a list of these and the restrictions.

 

[lannafo]

We use encoder pro and if it states the CPT is allowed by a PA, we print the encoder confirmation and include the OP notes with the appeal and it usually works. If the encoder states not allowed it could result in a w/o.