1
Palmetto GBA
Palmetto GBA

Required items feature an asterisk (*).

Thank you for contacting us. Your inquiries and comments are always welcome at Palmetto GBA. Please complete and submit the form below.

In order to ensure your privacy, please do not transmit any of the following information to Palmetto GBA. Revealing this information online could expose you or others as a target for Medicare fraud and abuse.
  1. Personal information, including Social Security numbers, which you would like to keep private.
  2. Beneficiary information, including Medicare Beneficiary Identifiers (MBIs), Health Insurance Claim (HIC) Numbers, coinsurance and deductible information, dates of Medicare entitlement, copies of or information from Medicare claim forms, Medicare reports of eligibility, and Medicare Summary Notices (MSNs).
  3. Information covered under the Freedom of Information Act (1967) and/or the Privacy Act of 1974.
  4. Claim specific data.



Feedback
First Name: *
Last Name: *
Company:
City: *
State: *
Zip Code: *
Phone: *
Extension: *
Email: *
Subject: *
*
Please retype the following two digit number*:
53
Thank you for contacting us!



© 2024, Palmetto GBA, LLC