Jurisdiction M 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 (PDF) 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).
Palmetto GBA EDI has created an overview of the JM Part A EDI Enrollment process (PDF) outlining EDI options available to all submitters.