eServices Form: General Inquiry Form

Published 05/08/2018

eServices users can submit a general inquiry request form to our Provider Contact Center through the eServices portal. Submitting these requests through eServices gets your form to Medicare more quickly than mailing or faxing a paper form and eServices allows you to track your form from submission through completion. 

The General Inquiry Form should be used for issues not addressed on any other eServices form. Other forms available in eServices include:

  • Reopening: Simple Claim Correction
  • Reopening: Simple Claim Correction - Late Submission
  • Redetermination: 1st Level Appeal
  • Redetermination: 1st Level Appeal - Late Submission
  • Redetermination: Overpayment Appeal
  • Redetermination: Overpayment Appeal - Late Submission
  • Medical Review ADR Response Form
  • eCheck Form
  • eOffset Form

Not an eServices user yet? Sign up today to take advantage of online form submissions and the other time saving features including online eligibility and claim status, online remittances, and eClaim submissions.

You can participate in eServices if you have a signed electronic data interchange (EDI) Enrollment Agreement on file with Palmetto GBA and a finalized claim in history. If you are already submitting claims electronically, you do not have to submit a new EDI Enrollment Agreement. See the eServices Portal section of our website for more information.

Instructions for submitting a form in eServices can be found in the eServices User Manual (PDF, 8.58 MB), Section 8.0 Secure Messaging and Forms.

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