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EDI
Palmetto GBA's Electronic Data Interchange (EDI) division encourages providers to submit their claims electronically and to utilize certain electronic features we offer. These electronic services allow providers to submit claims using a computer, software and modem instead of paper. You can also access certain claim and patient eligibility records and retrieve your remittance notices electronically.
The Administrative Simplification Compliance Act (ASCA) prohibits Medicare coverage of claims submitted to Medicare on paper, except in limited situations. All initial claims for reimbursement from Medicare must be submitted electronically, with limited exceptions.
The Centers for Medicare & Medicaid Services (CMS) has approved version 4010A1 (also referred to as "the Addenda") as the exclusive version for all ANSI X12N electronic transaction sets used by Medicare. Information on Implementation Guides, the X12N Data Dictionary, and ANSI Remittance Codes may be found at Washington Publishing Company's Web site http://www.wpc-edi.com/.
About Palmetto GBA EDI Support
You can check the status of Ohio Part B EDI Systems by selecting the EDI System Status option on the left tool bar. This pop-up window will display the current status for each system and will automatically refresh every 60 seconds so you can keep it up during the day. We will update the EDI System Status window with information on any system-related issue. When a problem occurs, such as a delay with posting remittance files, a detailed informational message will appear below the system affected. This message will be updated until the problem has been corrected. Please visit this area on the Palmetto GBA Web site prior to calling the Palmetto GBA Technology Support Center with system status questions.
Register on the Palmetto GBA Web site to receive EDI news electronically. By selecting "E-mail Updates" (which displays at the top of this page) and completing a user profile, you will be notified via e-mail when new or important EDI information is added to our Web site. If you have already registered, please ensure your profile has been updated for all new applicable EDI categories, including the EDI topic located under the Ohio Part B category. Users of Palmetto GBA-provided PC-ACE Pro32, Passport or MREP software should select the Palmetto GBA Software Users topic located under the General category. The General category also includes a special topic for Vendors, Clearinghouses and Billing Services.
Please contact the EDI Technical Support Team toll-free at 1-866-308-5438 for EDI-related assistance. You may e-mail us at by clicking on Contact Us in the red banner on the top of this page.
The CMS Web site http://www.cms.hhs.gov/ElectronicBillingEDITrans/ also includes detailed information on the EDI Transactions. |