Palmetto GBA Medicare Electronic Data Interchange is pleased to offer online enrollment for Electronic Remittance Notices (ERNs) and GPNET Online Service Inquiry for Claim Status Inquiry (CSI). 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. CSI allows you to electronically check the status of production claims after they have passed the front-end edits and received claim control numbers.
Please note: You must have been issued a Submitter ID prior to completing this request form.
You must enroll for GPNet Online Inquiry Service and Electronic Remittances on separate forms. You cannot complete one form to enroll in both functions.
To complete the Online Enrollment Form for ERNs and GPNet Online Inquiry Service, please follow these instructions:
- Complete all required fields as indicated by an asterisk.
- The Company Name, Address & Contact Information should be the entity associated with the Submitter ID. For example, if a billing service or clearinghouse will be accessing CSI or ERNs on behalf of a supplier, please include the billing service or clearinghouse information in the Company Name, Address & Contact Information fields. Supplier information is requested at the bottom of the form. If the Supplier will be accessing CSI or Electronic Remittances directly, enter the Supplier information in the Company Name, Address & Contact Information fields.
- Select Part B of South Carolina.
- Select Providers/Corp Headquarter or Billing Service/Clearinghouse by clicking on the appropriate radio button.
- Select an option for CSI for GPNet Online Inquiry Service or ERN (you may only request one function per form submission).
- If you are completing online CSI enrollment, select Daily Online or Weekly by clicking on the appropriate radio button.
- Electronic Remittances are only created in the current HIPAA-compliant version of the ANSI 835 electronic format.
- Enter all applicable supplier number(s) to be added. If you are requesting access to more than five suppliers, please enter the first five supplier numbers and click Submit. Once you have submitted the first group, you may click the Back button on your Internet browser, change the supplier 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 Enrollment Form for ERNs and GPNet Online Inquiry Service