Online ERA /ERN and GPNet Report Restore Form

Palmetto GBA Medicare Electronic Data Interchange (EDI) is pleased to offer an online form for the restoration of electronic remittance notices/advices (ERNs/ERAs) and GPNet Response Reports (999 & 277CA).

ERNs/ERAs and GPNet Response Reports are available for restore 20 business days prior to today’s date. Remit files and reports will be restored to your electronic submitter mailbox. The requestor will receive a confirmation by email.

Note: If you receive your Response Reports and/or Remit files from a clearinghouse, please confer with them prior to completing a request. Restorations will include all providers linked to the requested Submitter/Receiver ID.

Please complete all fields in the attached form. Incomplete forms will not be processed.The form fields are described below:

Form Field NameInstructions for Field Completion
Choose Medicare Contract Left click on arrow and select appropriate contract
Submitter ID The ID that was issued by Palmetto GBA upon completion of your EDI application form. This ID may also be referred to as a Receiver ID.
Submitter Name Enter the name of the entity which was assigned the Submitter ID/Receiver ID

Restore Options

Click on arrow and select Restore Option ERNS or Reports

Check/EFT Number(Will only appear when ERNs is selected as Restore Option)  Enter the Check/EFT number to be restored
ISA 13 File ID
(Will only appear when Reports is selected as Restore Option)
Enter the File ID to be restored. This will appear in the ISA13 of the 837 file submitted.
Date Left click in field and a calendar will appear. Select the date to restore.
Email Address Enter the email address. The confirmation will be sent to this address.
Requestor Name Enter the name of the person submitting this request
Contact Phone Number Enter the area code and phone number of requestor listed above

Do not attempt to combine GPNet Response Report requests and ERN/ERA requests. They should be separate requests.

Access the Online ERA Report Restore Form.

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Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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