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Printed Date: 9/22/2015
Palmetto GBA's Electronic Data Interchange (EDI) division encourages providers to submit their claims electronically and to utilize certain electronic features we offer. These electronic services allow providers to submit claims using a computer, software and modem instead of paper. You can also access certain claim and patient eligibility records, and retrieve your remittance notices electronically.
The Administrative Simplification Compliance Act (ASCA) prohibits Medicare coverage of claims submitted to Medicare on paper, except in limited situations. All initial claims for reimbursement from Medicare must be submitted electronically with limited exceptions.
The Centers for Medicare & Medicaid Services (CMS) has approved version 5010 Base and Errata as the exclusive version for all ASC X12N electronic transaction sets used by Medicare. ASC X12 TR3 Implementation Guides for v5010 transactions are available through the ASC X12 Store. New submitters will need to complete the EDI Enrollment Packet to request a Submitter ID. Vendors/Trading Partners will need to complete an EDI Application form to request a Vendor Submitter ID prior to testing. Submitters who use approved vendor-supported systems are not required to submit test claims with Palmetto GBA. If you use PC-ACE Pro32 software, please ensure you are using the most current version of the Palmetto GBA-issued software. The GPNet Communications Manual includes information about GPNet, Palmetto GBA’s EDI Gateway.
About Railroad Medicare EDI Web Pages
General EDI information articles appear under the General Web page. EDI enrollment forms can be found on the Enrollment Web page. The Software & Manuals Web page includes user manuals and software download information. The Technical Specifications Web page includes Companion documents and other materials in support of the approved ASC transaction sets. The RR EDI FAQ page includes answers to frequently asked EDI questions.
About Palmetto GBA EDI Support
You can check the status of Railroad Medicare Systems by selecting the EDI System Status option. This window will display the current status for each system. We will update the EDI System Status window with information on any system-related issue. When a problem occurs, such as a delay with posting remittance files, a detailed informational message will appear below the system affected. This message will be updated until the problem has been corrected. Please visit this area on the Palmetto GBA website prior to calling the Palmetto GBA Provider Contact Center with system status questions.
Register on the Palmetto GBA website to receive EDI news electronically. By selecting Listservs at the top this page and completing a user profile, you will be notified via email when new or important EDI information is added to our website. If you have already registered, please ensure your profile has been updated for all new applicable EDI categories, including the EDI topic located under the Railroad Medicare category. Users of Palmetto GBA-provided PC-ACE Pro32, Passport or MREP software should select the Palmetto GBA Software Users topic located under the General category. The General category also includes a special topic for Vendors, Clearinghouses and Billing Services.
Please contact the Palmetto GBA Provider Contact Center toll-free at 888-355-9165 for EDI-related assistance. You may also email us by clicking on Contact Us at the top of this page.
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Last Updated: 10/01/2019