Palmetto GBA Medicare Electronic Data Interchange (EDI) is pleased to offer online enrollment for Electronic Remittance Advices (ERAs). Electronic remittances are electronically downloaded notices that duplicate the information contained in paper remittances. Electronic Remittances are only created in the current HIPAA-compliant version of the ANSI 835 electronic format.
Note: You must have been issued a Submitter ID/Receiver ID prior to completing this request form.
To complete the Online ERA Enrollment Form, please follow these instructions:
- Complete all required fields as indicated by an asterisk
- The Company Name, Address & Contact Information field should be the entity associated with the Submitter ID/Receiver ID. For example, if a billing service or clearinghouse will be downloading ERAs on behalf of a provider, please include the billing service or clearinghouse information in the Company Name, Address & Contact Information fields. Provider information is requested at the bottom of the form. If the Provider will be accessing ERAs directly, enter the Provider information in the Company Name, Address & Contact Information fields.
- Select which line of business, either Part A of South Carolina(SE/SW), Part A of North Carolina or Part A Gulf Coast / Midwest (GCMW)
- Select Providers/Corp Headquarter or Billing Service/Clearinghouse by clicking on the appropriate radio button
- Enter all applicable provider number(s) to be added. If you are requesting access to more than 10 providers, please enter the first 10 provider numbers and click Submit. Once you have submitted the first group, you may click the Back button on your Internet browser, change the provider numbers and click Submit again. Remember to record your Request ID Number after each submission.
- Record your Request ID Number after each submission. If you do not receive a Request ID Number after clicking Submit, you may click the Back button on your Internet browser to enter corrected information in all fields.
Online ERA Enrollment Form