Palmetto GBA is pleased to offer an online request form to request an Electronic Data Interchange (EDI) Submitter ID number for Medicare Part B (MEDB), Medicare Part A - Southeast and Southwest (MEDA SESW), and Medicare Part A for North Carolina (MEDA NC). This online request is for Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant ANSI 837 claims and ANSI 835 electronic remittances.
To complete the Submitter ID Online Form, please follow these instructions:
- Complete all fields indicated with an asterisk (*)
- Indicate the correct type of Entity and Line of Business
- Record your Request ID number after submitting
- The Submitter ID will be mailed to the address indicated on the request
Submitter ID Online Form