Palmetto GBA - Ohio Part B Carrier

Provider Enrollment

Provider Enrollment Resources:

Enroll, change your Medicare information, and add or delete group members or locations online: https://pecos.cms.hhs.gov (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)
Access CMS-855 forms (then print, sign and mail to Palmetto GBA)
Palmetto GBA mailing addresses
Access the status of your CMS-855 application
Guidance on which form to complete
Contact the Provider Enrollment Support Line at (866) 308-5439 for additional assistance

Provider Enrollment

855 Application

General

IDTF

Opt Out

last updated on 11/20/2009