Progress | Innovations


A Foundation of Ingenuity


Refined Innovations

Suite of eServices

Palmetto GBA continues to develop new self-service tools for our industry-leading provider portal, eServices. In 2018, the Palmetto GBA team made updates to the portal, making it available for JJ MAC providers. These enhancements lessened users’ registration burden and allowed access to JJ MAC source data.

Additionally, Palmetto GBA rolled out the new Medicare Beneficiary Identifier (MBI) Look-up tool to all users. This tool allows providers to crosswalk a beneficiary’s Social Security Number (SSN)-based Health Insurance Claim Number (HICN) to their new MBI. In the event the beneficiary did not bring their MBI card to their appointment, this tool can be used to look up that information.

Click here for details on the MBI Lookup Tool.

Security enhancements remain in the forefront while we continue to implement improvements related to the provider’s experience. Focus groups with providers remain a vital approach for a better understanding of how our portal can enhance the efficiency of their operations.

Debt Management System (DMS)

Palmetto GBA seeks to modernize Medicare debt management activities. In 2018, we continued to implement enhancements to DMS, addressing system performance, audit trail management and request management. A significant enhancement was implemented to allow DMS to generate and manage notification letters to the provider community. Utilizing integration with print/mail services and eServices, DMS now sends Appeal New Notification letters to providers upon receipt of a confirmed Appeal Request. Letters are sent systematically via hard copy or greenmail, which is managed by the provider through its eServices account. Finally, updates were made to implement the JJ MAC lines of business into the DMS. The implementation of the new JJ MAC into the DMS was virtually seamless, with both lines of business fully operational in DMS on the go-live date.

Intelligent Document/Data Automation (iDA)

We continue to develop our ability to collect and process clinical data (in an electronic and automated format) that we receive from the provider community in support of medical review documentation requests, appeals support and prior authorization requests. iDA includes the tools to augment and automate the adjudication of these records. This project also includes expanding the communication routes with providers that facilitate direct data exchanges with their EHR systems (i.e., Direct Secure Messaging [DM], Fast HealthCare Interoperability Resources [FHIR] APIs). Both of these pathways are active elements of our current iDA projects.

iDA also includes the implementation of Natural Language Processing (NLP) and Artificial Intelligence (AI) to assist a reviewer in making a clinical decision. We are currently reviewing and piloting several AI-based products that support clinical decision-making.



Enhanced Security Systems

The Centers for Medicare & Medicaid Services (CMS) increased its focus on systems security and heightened its number of security requirements, including a 20 percent increase in controls in 2018. To meet — and exceed — these expectations, Palmetto GBA remains committed to improved overall system security.

In the last year, Palmetto GBA made more than 25 enhancements to the Security Manager Application, including the ability to process the new Jurisdiction J (JJ) A/B Medicare Administrative Contractor (MAC) information. Continued automation has reduced audit issues, errors and costs associated with the controls, and we are planning further developments in 2019.

Palmetto GBA continues to focus on the overall compliance of our systems security program. Year two of the Federal Information Security Management Act (FISMA) testing was completed in May 2018 with our best results ever. This is an accomplishment in light of the increased number of controls tested and the number of prior controls that had been modified.

The IP-360 System Security score provides CMS with a viable and base metric for measuring information technology risk on our Medicare network. Maintaining an “A” is a strong indicator that Palmetto GBA’s patch and configuration management programs are working well, even considering the major challenges presented by Meltdown and Spectre.

IP-360 System Security maintained an “A” rating for 71 consecutive months.