In 2024, Palmetto GBA continued to enhance the chat experience for our providers. We already are the only Medicare Administrative Contractor (MAC) to have provider authentication capabilities for chat services. This allows our customer service representatives to securely access customer information, so they can provide individualized service.  

In November, Palmetto GBA launched another first for fee-for-service Medicare. Sage, an Artificial Intelligence (AI) chatbot, went online to answer Claims Status inquiries for our Part A and Home Health and Hospice providers. Due to high demand and satisfaction, Sage was extended to the Part B community. It also was made available outside live agent hours and now answers questions daily from 6 AM to 9 PM. Sage currently handles nearly 600 chats daily – exceeding those handled by live agents.

Since its launch, Reason Codes, Claim Adjustment Reason Codes and Remittance Advice Remark Codes have been added to claims inquiries. We will continue to expand Sage’s capabilities to benefit our provider community.   

Creating Medicare’s first chatbot was both exciting and challenging for the product team. They initiated the project by analyzing Palmetto GBA’s chat history then categorizing and ranking the chat requests. The top inquiry, Claim Status, was the first implemented and proved difficult as the data for Part A and Part B is stored very differently.  Since security is always a priority, clever solutions were developed for the bot to thwart Data Phishing threats. The team also enjoyed a fun exercise to name and personify the new bot, and after a few weeks of development, Sage was born.