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Jurisdiction 11 Home Health and Hospice
Provider Enrollment

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:

    Palmetto GBA
    Part A Provider Enrollment (AG-331)
    2300 Springdale Drive, BLDG One
    Camden, SC 29020

 



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Revalidation Initiative: Frequently Asked Questions (FAQs)04/11/2014
List of Providers sent a Revalidation Request03/13/2014
Provider Enrollment Application: Frequently Asked Questions03/05/2014
Change of Information01/22/2014
Implementation of Provider Enrollment Provisions in CMS-6028-FCOpen in New Window12/10/2013
Important Information on the Revalidation of Medicare Provider Enrollment08/01/2013
Medicare Physicians and Non-Physician Practitioners: Protecting Your Privacy, Protecting Your Medicare Enrollment Record07/01/2013
Revalidation Checklist10/07/2012
Provider Transaction Access Number (PTAN) Issue07/30/2012
Were You Sent a Request to Revalidate Your Medicare Enrollment?06/12/2012
Major Improvements: Internet-based PECOS05/15/2012
How to Check the Status of Your Provider Enrollment Application01/23/2012
Sample Revalidation Letter01/19/2012
Guidance on Completing the CMS-855A Enrollment Form11/22/2011
Effective Date of Certified Provider or Supplier Agreement or Approval04/04/2011
Internet-Based Medicare Enrollment Application01/14/2011
Medicare Enrollment: Fact Sheets01/14/2011
Capitalization Requirement for Home Health Agencies (HHAs)01/21/2010

 

last updated on 4/01/2014
ver 1.0.43