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Printed Date: 9/22/2015
Palmetto GBA Medicare Electronic Data Interchange (EDI) is pleased to offer an online Direct Data Entry (DDE) enrollment form for Jurisdiction M North Carolina Part A, South Carolina Part A and HHH; as well as Jurisdiction J Alabama Part A, Georgia Part A and Tennessee Part A. DDE allows you to:
Note: Providers must have an EDI Enrollment Agreement (PDF, 506KB) on file before a request is submitted by the provider or on behalf of a provider by a Clearinghouse or Billing Service.
To complete the DDE ID Online Request Form, please follow these instructions:
Form Field Name
Enter the Submitter ID used by the submitter to communicate with Palmetto GBA electronically. If a site wishes for Online Inquiry Access and does not have a submitter ID, please enter five Xs (XXXXX) in the field.
Note: If a site has been issued a Submitter ID, it must accompany the request or the request will be denied.
Select only one request for the individuals listed below:
Record your Tracking Number after each submission. If you do not receive a Tracking Number after clicking Submit, you may click the Back button on your Internet browser to enter corrected information in all fields. You can check the processing status of your EDI request by entering your Tracking number onto the EDI Enrollment Status Online Request Form.
View the DDE ID Online Request Form.
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Last Updated: 05/15/2020