Provider Enrollment Resources:
- Enroll, change your Medicare information, and add or delete group members or locations online at https://pecos.cms.hhs.gov. Then print, sign and date the two-page Certification Statement and mail the Certification Statement and all supporting paper documentation to Palmetto GBA within seven days of electronic submission.
- Download the CMS-855A form. Then print, sign and mail it to Palmetto GBA.
- Access the status of your CMS-855 application
- CMS file: providers eligible to order/refer and with current enrollment records
- Enrollment Application Status Lookup
- Palmetto GBA address for mailing enrollment forms:
Part A Provider Enrollment (AG-331)
2300 Springdale Drive, BLDG One
Camden, SC 29020