Who is the Medicare carrier in Georgia and how do I become a provider?

Cahaba Government Benefit Administrators (GBA), a division of Blue Cross and Blue Shield of Alabama, is the Medicare Part B Carrier for the State of Georgia. (Cahaba GBA is named for the Cahaba River in Alabama.) You can reach them at:

Cahaba Government Benefit Administrators
Georgia Medicare Part B
P.O. Box 3018
Savannah, GA 31402-3018

Medicare Providers may call toll-free: 1-877-567-7271
http://www.gamedicare.com/

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How do I become a Medicare provider/supplier?

Call the Provider Enrollment Department toll-free at 866-582-3246 for specific provider enrollment inquiries. Provider Enrollment applications can be ordered from either the Provider Enrollment Department or from the Provider Inquiry Line toll-free at 877-567-7271. You may also download Provider Enrollment Applications on the Centers for Medicare and Medicaid Services (CMS) website at www.cms.hhs.gov/providers/enrollment/forms.

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How do I make a correction to my Georgia Medicare provider file?

Minor corrections such as address, phone number, etc., must be made on either the 855B (changing Group Provider information) or the 855I (changing Individual Provider information) forms. To request copies of these forms call 877-567-7271. If the changes are more complex, such as adding a practice location or making a Tax Identification Number change, please call toll-free 866-582-3246 for instructions.

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What are the required documentation items for new Medicare providers?

• State Medical License- A temporary license may be submitted with an application, but it is the provider’s responsibility to forward a copy of the permanent license when received. Without the permanent license, claims may not be paid past the expiration date of the temporary license.
• Copy of Diploma
• Drug Enforcement Agency (DEA) Certification
• Board Certifications
• Copy of Business License (if establishing new practice)
• IRS Documentation– CP-575 (if incorporated)
• Proof of Employment*– W2, W4**, billing agreement, etc. (if joining a group or organization)
• EDI Agreements– EDI, EFT (if applicable)
• CLIA Certificate (if applicable)
• Diabetes Education Certificate (if applicable)

* Providers who are reassigning benefits to an established hospital and certify on their enrollment application that they are W2 employees of said hospital, are not required to provide additional proof of employment information.

** To be a valid as proof of employment, a W4 must have the name of the employer and the Tax Identification Number on it.

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Where do I mail my Provider Enrollment Application?

Attn: Provider Enrollment
Georgia Medicare Part B
P.O. Box 3018
Savannah, GA 31402-3018

What are common reasons for delayed/returned provider enrollment applications?

The top five reasons applications are delayed or returned are:

1. 1099 independent contractor or billing agency indicated and no copy of contract is sent with the application (see below).

2. Application not signed or signatures look like they may not be original (i.e., rubber stamp signature).

3. Applications incomplete; sections left blank.

4. Application contains unverifiable information (e.g., telephone number, address, education, Social Security Number).

5. Applicant is on the Department of Health and Human Services (DHHS), Office of Inspector General (OIG) excluded providers list or the applicant’s license has expired.

Additional provider enrollment information such as a Form Guide, Specialty Code List, Definitions, Participation Agreement, Electronic Data Interchange (electronic claim filing) can be found at http://www.gamedicare.com/provider/NewProvEnrollInfo.htm

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Can I verify beneficiary eligibility on a patient?

Yes. Effective April 1, 2002 Medicare eligibility information is available by calling the Georgia Medicare Part B office toll-free at 1 877 567-7271 and speaking with a Customer Service Representative.

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If a patient has a Medicare card, does that guarantee eligibility?

Possession of a Medicare card is not a guarantee that a beneficiary still has Medicare. If coverage is terminated (e.g., due to unpaid premiums or withdrawal from the program), the beneficiary would still have a Medicare card. Providers may contact the Georgia Medicare Part B office toll-free at 1 877 567-7271 to verify Medicare eligibility.

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How do I check the status of a claim?

Possession of a Medicare card is not a guarantee that a beneficiary still has Medicare. If coverage is terminated (e.g., due to unpaid premiums or withdrawal from the program), the beneficiary would still have a Medicare card. Providers may contact the Georgia Medicare Part B office toll-free at 1 877 567-7271 to verify Medicare eligibility.

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How long should I wait to check claim status?

The Carrier has 30 days to process a claim. Providers should wait 30 days after submitting their claims before contacting the Carrier for a claim status check.

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Does Medicare have guidelines for required documentation?

Title XVIII, Section1833 (e) of the Social Security Act states…

“No payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period”.

There must be sufficient documentation in the medical records to substantiate the services being performed and to verify the services being billed. If there is no documentation, there is no justification for the services. If there is insufficient documentation to support claims that have already been paid by Medicare, the reimbursement made may be considered an overpayment and the funds may be recouped.

Local Coverage Determinations (LCDs) (formerly Local Medical Review Policies) are specific as to what documentation is required for the services or procedures in the coverage determinations. The Local Coverage Determinations for Georgia can be found at: http://www.gamedicare.com/policies/index2.htm

Some National Coverage Determinations (NCDs) are also specific as to what documentation is required for certain services or procedures. The National Coverage Determinations can be found at: http://www.cms.hhs.gov/coverage

Documentation guidelines for Evaluation and Management services can be found at: http://www.cms.hhs.gov/medlearn/emdoc

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How can I obtain Medicare/CMS publications?

Georgia Medicare Part B no longer publishes the Medicare News in hardcopy (paper) format. The Carrier will, however, mail a quarterly one-page flyer containing a summary of important articles in the previous quarter's monthly online newsletters beginning January 2003.

The Medicare News (monthly newsletter) will be available online at www.gamedicare.com/NewsPubs/index.htm. The newsletter will be available to download in its entirety in a PDF format. You may now sign up for email notifications (Listserv) at www.gamedicare.com/provider/ListServ/index.htm. For those offices that do not have internet access, you may contact Georgia Medicare Part B toll-free at 1 877 567-7271 to obtain a hardcopy.

Information about CMS publications is available on the CMS website at www.cms.hhs.gov.

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What should I do about Medicare Part B overpayments?

When you discover that you have been overpaid, or paid inappropriately, return the Medicare check to us, or send us your personal check for the amount of the overpayment. To ensure that we correctly credit your account, please do the following:

Medicare checks:

• Include a copy of the remittance with a completed Overpayment Refund Form
• Write VOID on the face of the check.

Personal checks:

• Include a copy of the remittance, highlighting the inappropriate payment.
• Include a completed Overpayment Refund Form

Send BOTH to:

Georgia Medicare Part B
Attn: Financial Department
PO Box 3018
Savannah, GA 31402-3018

When Medicare discovers that you have been overpaid, or paid inappropriately, we will send you an "overpayment letter" requesting that the money be returned. Mail your check with a copy of the letter to:

Georgia Medicare Part B
Attn: Financial Department
PO Box 3018
Savannah, GA 31402-3018

Please note: If you disagree with the information in our "overpayment letter," clearly state the reason why and mail your explanation to the above address.

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How can I find Georgia Medicaid's internet site?