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MAC Palmetto GBA releases many claims that were ‘incorrectly suspended’

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Many home health agencies were taken aback in early June after receiving what appeared to be additional documentation requests (ADRs) from SafeGuard Services LLC, a Unified Program Integrity Contractor (UPIC).

But it appears some claims were “incorrectly suspended,” according to a post on Medicare Administrative Contractor (MAC) Palmetto GBA’s website.

UPICs help address fraud, waste and abuse by performing regional Medicare and Medicaid data analysis, complaint resolution and investigative activities, according to SafeGuard’s website. Cases typically get referred to UPICs from MACs resulting from beneficiary/provider and whistleblower complaints. And providers may receive requests for copies of medical records from MACs, the UPIC or the Comprehensive Error Rate Testing (CERT) program.

According to a June 12 post from Palmetto GBA, which has 16 states in its home health territory, some agencies “may have had final (end of episode) claims suspended in processing location S B6000 with reason code (RC) 5Z7BS. In addition, requests for anticipated payment (RAPs) may have received line denials with RC 5Z74H. These RCs would normally identify SafeGuard Services (SGS), the Southeastern Unified Program Integrity Contractor UPIC, is conducting edits.”

Palmetto has “released all the final claims that incorrectly suspended in processing location S B6000 to allow normal processing,” Palmetto says in the June 12 post. “RAPs that have finalized with RC 5Z74H will be reprocessed by Palmetto GBA.”

Palmetto’s post notes that agencies in states within SafeGuard’s jurisdiction may have correctly received edits. If the claim goes into processing location S B6001, an agency should comply with the ADR.