Insulin Used with Continuous External Insulin Infusion Pumps - Correct Coding - Revised

Last Updated: 10/05/2021

Palmetto GBA Web Chat

Please answer the questions below. Additional fields may appear based on previous answers. Fields with a red asterisk (*) are required.

Your InformationClear

Name

E-mailPhone

1()-x

Inquiry InformationClear

How can we assist you today?

Please describe your inquiry.

Select your stateClear

State

Select your stateClear

State

Provider InformationClear

PTANNPI Last 5 of TIN

Patient InformationClear

Patient Name must exactly match the information submitted on the claim, including suffix if applicable.

Patient Name

MBI DOB

Appeal InformationClear

From DOS

To DOS

Last 5 of ICN Appeal DCN

Claim InformationClear

From DOS

To DOS

Total Amount Billed

Denial InformationClear

From DOS

To DOS

Total Amount Billed or Last 5 of Claim Number

Rejection InformationClear

Submitter ID

DDE InformationClear

DDE ID

Restore InformationClear

Submitter ID Receiver ID Date of File

Prior Authorization InformationClear

From DOS

To DOS

UTN

Application InformationClear

DCN / Web Track ID

POC/AP/DO Name

Product InformationClear

Manufacturer Product Name Product Number Product Description

OtherClear

Please describe your inquiry.

Additional InformationClear

Please provide any other information which may assist with your inquiry.

Are you sure you want to end your chat?

Keep Chatting Close Chat Save Transcript & Close