Palmetto GBA
Palmetto GBA is a Medicare Administrative Contractor that processes high-volume claims, administers provider enrollment, and operates specialized programs including MolDX molecular diagnostics and DMEPOS enrollment for CMS and the Railroad Retirement Board across 24+ states.
- Company typePrivate
- Founded1966
- HeadquartersColumbia, United States
- Headcount5,001–10,000
- GTM typeB2B
- OfferingServices
What Palmetto GBA does
Palmetto GBA, LLC is a privately held Medicare Administrative Contractor (MAC) founded in 1966 coinciding with the inception of the Medicare program, headquartered in Columbia, South Carolina, and operating as a subsidiary of the Celerian Group. The company processes high-volume Medicare claims, administers provider enrollment, operates contact centers, and provides technical services for the federal government. Palmetto GBA holds seven Medicare contract vehicles covering 24+ states and territories: Jurisdiction J (Part A and Part B for Alabama, Georgia, Tennessee), Jurisdiction M (Part A, Part B, and Home Health & Hospice for North Carolina, South Carolina, Virginia, West Virginia), the RRB Specialty MAC for national Railroad Medicare, MolDX for molecular diagnostic coverage administration, National Provider Enrollment West for DMEPOS supplier enrollment, DMEPOS Competitive Bidding, and the WTC Health Program.
The company's technical infrastructure centers on the eServices Portal (a secure web-based provider interface for eligibility verification, claims status, and financial information), the iFlow workflow management system, and the MolDX program which manages coverage decisions and reimbursement for molecular diagnostic tests on behalf of CMS. In 2025, Palmetto GBA launched SAGE, an AI-powered automated chatbot for the Provider Contact Center that delivers real-time claim status with reason codes in under three seconds. The company holds CMMI Level 5 and ISO 9001 certifications, reflecting process maturity consistent with high-stakes federal healthcare administration.
Palmetto GBA's revenue model is government managed services contracting, with revenue derived from CMS and the Railroad Retirement Board under multi-year MAC contracts. Pricing is not publicly disclosed and is negotiated through federal procurement processes. Customer segments include federal healthcare programs (CMS, RRB), Medicare providers (physicians, hospitals, home health agencies, hospice providers, DME suppliers), and railroad retirement beneficiaries. The company's go-to-market is not commercial sales but rather contract recompete and expansion within existing federal program mandates, supplemented by provider education events, email updates, and web-based portals for beneficiary and provider outreach. Neal Burkhead serves as President and Chief Operating Officer.
Palmetto GBA firmographics
Firmographics- Name
- Palmetto GBA
- Legal name
- Palmetto GBA, LLC
- Website
- https://palmettogba.com
- Company type
- Private
- Founded year
- 1966
- Operating status
- Operating
- Headcount range
- 5,001–10,000 employees
- Short description
- Palmetto GBA is a Medicare Administrative Contractor that processes high-volume claims, administers provider enrollment, and operates specialized programs including MolDX molecular diagnostics and DMEPOS enrollment for CMS and the Railroad Retirement Board across 24+ states.
- Ownership category
- akta.pro rank
Palmetto GBA industry classification
Industry- Product category
- Medicare Administrative Services
- NAICS
- Health and Welfare Funds (525120)
- SIC
- Hospital & Medical Service Plans (6324), Services-Computer Programming, Data Processing, Etc. (7370)
- akta.pro industry
- Medigap Plan Administration (Enrollment, Billing & Member Services)Healthcare & Life Sciences/Health Insurance & Managed Care/Medicare Supplement (Medigap) & Medicare Cost PlansMedicare Advantage (MA) Plans
Keywords
Where Palmetto GBA is headquartered
LocationHeadquarters
- HQ city
- Columbia
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
Palmetto GBA business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales, Others
Revenue model
- Government Contract Revenue: Revenue generated through government contracts with CMS and the Railroad Retirement Board for administering Medicare programs including claims processing, provider enrollment, and contact center operations
Go-to-market motion1 record
Distribution channels6 records
Marketing channels5 records
Palmetto GBA product offering
Product offeringCore offering
Palmetto GBA serves as a Medicare Administrative Contractor (MAC) providing high-volume Medicare claims processing, provider enrollment, contact center operations, and technical services to the federal government across multiple jurisdictions including Jurisdiction J (AL, GA, TN), Jurisdiction M (NC, SC, VA, WV), and the RRB Specialty MAC for national Railroad Medicare. The company also administers specialized programs such as MolDX for molecular diagnostics coverage and the National Provider Enrollment West for DMEPOS supplier enrollment.
Product overview
Palmetto GBA is a Medicare Administrative Contractor (MAC) providing high-volume claims processing, contact center operations, and technical services to the federal government. The company's portfolio consists of multiple MAC jurisdictions (Jurisdiction J covering AL, GA, TN; Jurisdiction M covering NC, SC, VA, WV; and RRB Specialty MAC for Railroad Medicare nationwide), supplemented by specialized programs including MolDX for molecular diagnostics coverage, National Provider Enrollment West for DMEPOS supplier enrollment, PDAC for coding guidance, and DEX Z-Codes. These operate through web-based platforms including the eServices Portal for providers and MyRRMed for beneficiaries. The company also recently introduced SAGE, an AI-powered automated assistant for its Provider Contact Center.
Differentiator
Problem solved
Functional benefit
Products and services
- Jurisdiction J MAC Services (Part A & Part B)
Companies that use Palmetto GBA
Customer profileNamed customers4 records
Segments3 records
Ideal customer profiles3 records
Palmetto GBA technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration3 records
AI capability1 record
Feature3 records
Palmetto GBA partnerships and signals
Strategic signalPartnerships
Three partnerships are on record, tiered core.
- CMS (Centers for Medicare and Medicaid Services)corePrimary government contracting relationship where Palmetto GBA serves as Medicare Administrative Contractor for multiple jurisdictions handling claims processing, provider enrollment, coverage determinations, and fraud detection programs like MolDX
- Railroad Retirement Board (RRB)coreFederal agency contracted to process Part B claims for Railroad Retirement beneficiaries nationwide through the RRB Specialty MAC
- Celerian GroupcorePalmetto GBA is A Celerian Group Company, operating as part of the parent organization's portfolio of government healthcare administrative services
Scale indicators4 records
Recent moves6 records
Expansion highlights5 records
Palmetto GBA competitors and assessment
Company assessmentDirect peers
- Novitas Solutions: Another Medicare Administrative Contractor (MAC) that processes Part A/B claims and related services across multiple jurisdictions, including NPEast for DMEPOS supplier enrollment — directly comparable as a fellow A/B MAC competing with Palmetto GBA in federal recompetes.
- CGS Administrators: A MAC providing Medicare claims administration for Jurisdiction 15 (Ohio, West Virginia) and Jurisdiction C and DMEPOS Jurisdiction D, directly competing with Palmetto GBA on federal contract scopes.
- WPS Government Health Administrators: A MAC serving multiple jurisdictions for Part A/B Medicare claims processing and related services, a direct competitor in the federal MAC recompete landscape.
- National Government Services (NGS): A national MAC processing Medicare claims across several U.S. jurisdictions; competes with Palmetto GBA for jurisdiction contracts and similar fee-for-service administrative work.
- First Coast Service Options: A MAC and MolDX program participant handling Medicare claims and certain coverage programs; overlaps with Palmetto GBA on MAC and DMEPOS workloads.
- Noridian Healthcare Solutions: A MAC administering Medicare Fee-for-Service claims across multiple jurisdictions and DMEPOS programs, in direct competition with Palmetto GBA in MAC recompetes.
Broad incumbents
- Conduent: A large government services BPO providing healthcare claims, eligibility, and citizen services for federal and state agencies, overlapping Palmetto GBA's high-volume transaction processing business across multiple verticals.
- Maximus: A government services contractor operating large-scale health and contact center operations for federal agencies (including CMS-adjacent programs), comparable in scale and contract structure to Palmetto GBA.
- CGI Federal: An IT services and BPO contractor for federal health programs (including CMS), with comparable claims processing and systems integration capabilities to Palmetto GBA.
- Booz Allen Hamilton: A federal health consulting and technology integrator supporting CMS, VA, and DHA, with overlapping capability footprint around health program operations and analytics relevant to MAC work.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat6 records
Key risks6 records
Key highlights7 records
Customer concentration
Palmetto GBA social profiles
Digital presencePalmetto GBA compliance and trust
Trust signalCompliance2 records
Palmetto GBA financial estimates
Financial estimateRevenue estimate
Valuation estimate
Palmetto GBA leadership team
Management profileNumber of profiles
Profiles3 records
Palmetto GBA funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Palmetto GBA M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Palmetto GBA
What does Palmetto GBA do?
Palmetto GBA serves as a Medicare Administrative Contractor (MAC) providing high-volume Medicare claims processing, provider enrollment, contact center operations, and technical services to the federal government across multiple jurisdictions including Jurisdiction J (AL, GA, TN), Jurisdiction M (NC, SC, VA, WV), and the RRB Specialty MAC for national Railroad Medicare. The company also administers specialized programs such as MolDX for molecular diagnostics coverage and the National Provider Enrollment West for DMEPOS supplier enrollment.
Is Palmetto GBA a public or private company?
Palmetto GBA is a private company. It is classified as corporate owned and is currently operating.
When was Palmetto GBA founded?
Palmetto GBA was founded in 1966. It employs 5,001 to 10,000 people.
Where is Palmetto GBA based?
Palmetto GBA is headquartered in Columbia, United States, in the North America region.
How does Palmetto GBA make money?
One revenue line is on record: government Contract Revenue.
Who are Palmetto GBA's main competitors?
Direct peers on record are Novitas Solutions, CGS Administrators, WPS Government Health Administrators, National Government Services (NGS), First Coast Service Options and Noridian Healthcare Solutions. Broad incumbents are Conduent, Maximus, CGI Federal and Booz Allen Hamilton.
Does Palmetto GBA have an API?
No public API is recorded for Palmetto GBA.
What industry is Palmetto GBA in?
Palmetto GBA's product category is Medicare Administrative Services. Its primary akta.pro industry code is HLAEADAC, Medigap Plan Administration (Enrollment, Billing & Member Services), with a secondary code of FSAIAGAA, Medicare Advantage (MA) Plans. Its NAICS code is 525120 and its SIC code is 6324.