Jurisdiction J Part A providers will need the following information to enroll in Electronic Data Interchange (EDI): Provider Transaction Access Number (PTAN), National Provider Identifier (NPI), and demographic information for the location.
- If you only want access to Palmetto GBA’s eServices portal, please fill out an EDI Enrollment Agreement (PDF) with separate EDI Enrollment Agreement instructions (PDF).
- If you will be submitting directly to Palmetto GBA and not using a clearinghouse, please complete the Direct Submitter forms with separate Direct Submitter forms instruction (PDF). You will need to select a Network Service Vendor (PDF) or an Approved Vendor (PDF) if you have not already chosen one.
- If you are using a Billing Service or a Clearinghouse to submit your claims, please complete the Billing Service-Clearinghouse forms (PDF) with separate Billing Service-Clearinghouse forms instruction (PDF) once you have discussed what EDI services they will be providing for you.
- If you only need to be assigned a Direct Data Entry (DDE) ID, and did not have one previously assigned to you, please complete the DDE New Request forms (PDF) with separate DDE New Request forms instruction (PDF).
- If you currently have an active DDE ID and only need your PTAN(s) added to it, please complete the DDE Update Form (PDF) with separate DDE Update Form instructions (PDF).