Palmetto GBA successfully retained the CSFES contract in a recent Centers for Medicare & Medicaid Services’ procurement.

Palmetto GBA operates the Electronic Data Interchange (EDI) gateway and processes files within four front-end Information Technology systems: Encounter Data System Front End System (EDFES), Front End Risk Adjustment System (FERAS), Prescription Drug Front End System (PDFS), and Medicare Medicaid Plans (MMP) Front End System. The CSFES team collects and processes risk adjustment, prescription drug event, encounter, Medicaid, and National Council for Prescription Drug Program data from trading partners. In 2023, Palmetto GBA collected over four billion transactions to support these programs.  

In addition to data processing, Palmetto GBA provides customer service and support through a technical help desk, multiple websites and outreach and education to health plans.

The team also produces front-end system processing reports, receives back-end system processing files, and routes these reports to the trading partners. Palmetto GBA’s Medicare Statistical Analysis Department uses innovative approaches for big data management to summarize submission trends and processing outcomes.

Nella Bishop, CIO and Vice President of Systems and Support, who oversees the contract, expressed her enthusiasm: “We are thrilled to have been awarded this contract, which we have held since the inception of the Medicare +Choice (now Medicare Advantage) Program. This award reaffirms our commitment to providing the best solutions for our customers, as the contract has now been expanded to include Medicare prescription drug coverage, work related to the current Inflation Reduction Act, and the new dental transaction processing. This achievement aligns perfectly with our mission to enhance healthcare delivery efficiency and effectiveness.”