Success Metrics | Growth
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Jurisdiction M A/B Medicare Administrative Contractor (MAC)
Palmetto GBA was awarded the contract for Jurisdiction M A/B MAC covering South Carolina, North Carolina, Virginia and West Virginia. Under this contract, Palmetto GBA also administers the Medicare Home Health and Hospice (HHH) benefit for Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and Texas. This is Palmetto GBA’s largest contract.
The scope of this contract is significant. Palmetto GBA performs all the Medicare Parts A and B administration for the jurisdiction including provider enrollment, outreach and education, claims processing, appeals, provider customer service, medical review, and audit and reimbursement. As of September 30, 2022, the region includes:
Total Number of Part A/Part B Fee-for-Service Beneficiaries: 3,069,107
Total Number of HHH Fee-for-Service Beneficiaries: 14,287,496
Total Number of Physicians: 76,992
Total Number of Medicare Hospitals: 315
Total Number of Home Health Agencies: 5,786
Total Number of Hospices: 2,193
Total Annual Claims Volume: 8.1% of national Part A/Part B workload
Total Annual Claims Volume: 50.2% of national HHH workload
There is tremendous value in winning contract recompetes — for our customers, the communities we serve and our employees. It means consistency in the relationships, a seamless move to a new contract, and the customer already knows what to expect from us. Successful recompetes truly are a credit to the trust our customers have in us.”
Arteya Robinson
Audit & Reimbursement Director, Jurisdiction M
National Supplier Clearinghouse (NSC) Medicare Administrative Contractor (MAC) Transitions to National Provider Enrollment (NPE) West
Palmetto GBA has been the administrator for the NSC MAC since the program’s inception in 1993. Last year, the contract was divided into two regions and re-competed as the NPE East and West task orders.
Palmetto GBA was awarded the western region and is responsible for issuing or revoking Medicare billing privileges for suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) in states west of the Mississippi River and the three U.S. Territories of American Samoa, Guam and the Northern Mariana Islands. Under the NPE West, we will continue to ensure enrolled suppliers meet all required supplier standards and federal and state requirements, as well as implement controls to combat fraud, waste and abuse, and maintain a data repository of DMEPOS suppliers. The NPE West was developed because of the unique and specialized requirements that distinguish DMEPOS supplier enrollment from other Medicare and Medicaid providers and suppliers, especially related to surety bonding, special licensing, insurance and inventory.
General Services Administration (GSA) IT Schedule 70
Palmetto GBA was awarded a seat on the GSA IT Schedule 70 contract. Vendors awarded this contract are pre-approved by the GSA to deliver a streamlined purchasing process for information technology services.
