Part B MayFest 2021: Learn about the Railroad Medicare Program with a Spotlight on CERT Webinar: Questions

Published 06/08/2021

The following questions were received and answered during our May 20, 2021, MayFest webinar.

Question 1: I am trying to change our clearinghouse, but I am being denied because our address is incorrect. How can I find out what address Railroad Medicare has on file?

Answer: Please call our Provider Contact Center (PCC) at 888–355–9165. Choose option 3 to speak with Provider Enrollment. They will be glad to verify the address we have on file for you. 

Question 2: Since we don't have a lot of Railroad Medicare claims throughout the year would it be better to just manually submit our claims by paper? I can't see if a claim is processing or has been accepted when it has to do with Railroad Medicare. 

Answer: You would need to meet an exception to mandatory billing of electronic claims to be able to submit paper claims. You can find information about the options for submitting claims to Railroad Medicare on our Claims page. The options include submitting electronic claims, submitting paper claims, and submitting paperless eClaims in our eServices portal. 

If you are trying to submit electronic claims to Railroad Medicare and you are not getting responses back or you have concerns about whether the claims are being accepted, please make sure you are truly registered to submit claims electronically to Palmetto GBA Railroad Medicare. We do have issues sometimes with providers whose Railroad Medicare claims are being included in the batches sent by their clearinghouse or billing agency to their local Part B MAC rather than coming to Railroad Medicare, or situations where the clearinghouse or billing agency is trying to submit directly to Railroad Medicare but they are not set up to do so. Just because they have the payer ID for Railroad Medicare doesn’t mean they have the appropriate EDI Enrollment forms on file to allow them to submit electronic claims to us. If you need to verify if we have you set for electronic billing to Railroad Medicare, please call our Provider Contact Center and choose the option for EDI so you can speak with an EDI specialist. They will be glad to verify that for you. 

Addendum: You can reach our PCC representatives at 888–355–9165 (Monday through Friday, 8:30 a.m. to 4:30 p.m. ET for all time zones with the exception of PT, which receives services from 8 a.m. to 4 p.m.).

To connect with an EDI representative, select option 2 from the main menu for EDI/eServices. Then select option 0 for technical assistance with electronic billing, Electronic Remittance Advice (ERA) or other EDI issues.

Question 3: Can a Railroad Medicare beneficiary have a Medicare Advantage plan?

Answer: Yes. Railroad Medicare beneficiaries can enroll in Medicare Advantage plans. When you check eligibility for your patient through the IVR, the eServices portal or through your MAC portal, you should be able to get information back on whether a beneficiary is in a Medicare Advantage plan. Also, when you see a patient in your office, especially if they are a new patient, make sure to ask them to present all of their insurance cards. Railroad Medicare beneficiaries who are enrolled in a Medicare Advantage plan will still have Railroad Medicare cards with an MBI number, but they should also have a card from the Medicare Advantage plan and that is the card that they should be presenting to you.  

Question 4: I am a rural health care independent provider and I would like to verify that I am to submit Railroad Medicare claims to Part A? Part A has been paying, but I would like to confirm.

Answer: Yes, you should submit those claims to Part A. When it comes to Rural Health Clinic (RHC) claims, bill the claims the same way you would if the patient had Social Security Medicare. If the claim is something you would bill to Part A for a Social Security Medicare beneficiary, do the same thing for a Railroad Medicare beneficiary. If the service is something you would be paid for outside of your RHC payment and that you would normally break off and submit to Part B on a CMS-1500 claim form or equivalent electronic claim, then you would do the same for a Railroad Medicare beneficiary, but those claims would be billed to the Palmetto GBA RRB SMAC for processing. 

Question 5: Is a separate log in required for Railroad Medicare? I have an eServices log in because we are in Jurisdiction J.

Answer: Yes, you will need to register a separate eServices account for Railroad Medicare, and you will be assigned a different User ID for the for the Railroad Medicare account. Once you register the Railroad Medicare account, you can then link it with your Jurisdiction J or M account or to other Railroad Medicare accounts, which will allow you to log in with a single default log in. You can find complete instructions for linking accounts in the eServices User Manual.

Question 6: I think I linked my accounts a couple of years ago. How can I check on this? 

Answer: You can call the Provider Contact Center and speak with an eServices specialist. They will be glad to verify that for you. 

Addendum: You can reach our PCC representatives at 888–355–9165 (Monday through Friday, 8:30 a.m. to 4:30 p.m. ET for all time zones with the exception of PT, which receives services from 8 a.m. to 4 p.m.).

To connect with an eServices representative, select option 2 from the main menu for EDI/eServices. Then select option 1 for eServices inquiries.

Question 7: If we serve patients in North Carolina and South Carolina, would the providers need two different PTANs?

Answer: Yes, they would. The same way the providers would need separate PTANs for each state with your Part B MAC, they will need separate Railroad Medicare PTANs for each state. If providers practice in different payment jurisdictions, they must have separate PTANs for each jurisdiction. We mirror Railroad Medicare enrollment on the provider’s enrollment with their Part B MAC. When requesting a Railroad Medicare PTAN in the PTAN Lookup and Request Tool, please make sure to enter the correct Part B MAC PTAN for the state/jurisdiction you are requesting a Railroad Medicare PTAN for.  

Question 8: What is the event code for this session? 

Answer: The course code for this event, which you can add to your Certificate of Attendance is RRB3101258.


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