Palmetto GBA
^ Back to Top
Close Window [x]
  • JM HHH
  • JM Part A
  • JM Part B
  • NSC
  • Railroad Beneficiaries
  • Railroad Providers

Auxilary Aids & Services

For information about the availability of auxiliary aids and services, please visit:

Bookmark E-mail Print FB Like Show/Hide Google+ line
Standard Font Serif Font Decrease Font Size Increase Font Size

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 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



last updated on 11/01/2015
ver 1.0.51