Palmetto GBA Railroad Medicare: Direct
Please follow the Enrollment Instructions below to become an electronic submitter for Railroad Medicare.
Required Documents for those applying for new Submitter IDs
The following documents are required enrollment documents that must be completed, signed and returned to the Palmetto GBA office prior to initiation of electronic claims submission or inquiry.
1. EDI Application Form
2. Medicare Electronic Data Interchange Enrollment Agreement
3. Provider Authorization Form (For Billing Services Only)
To obtain the forms above, please download them from:
If you have any questions regarding any of the documents in this package, please phone the Palmetto GBA EDI Technology Support Center at 1-888-355-9165.
We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.
Railroad Medicare EDI Information Application
In the Header please select the following:
Apply for New Submitter ID
If you wish to receive your remittance advice electronically, please also choose "Apply for New Receiver ID"
In the section that follows please enter the following:
Your name or Business name in the Submitter Name line
New applicants may leave the Submitter ID and ERN ID’s blank
For Type of Submitter choose either Billing Service or Provider
Enter the name of the contact person for your office and your demographic information
For Request Response Format: choose File
For Data Compression: choose PKZIP
For name of Software Vendor, enter the information for the software or vendor that creates your 837 files you need Claimshuttle to transfer for you. If you have paid for our SolAce billing software please call our support line for our SolAce software information.
If you are a provider submitting for yourself, enter your information in the “Provider for whom submitter will be transmitting” section and check the “Yes” box for “Enrollment Attached?” Also check the boxes for “Submit Claims, Receive Electronic Remittances, and Receive Reports”
If you are a Billing Service, please enter the name of the provider that you will be billing for and check the “Yes” box for “Enrollment Attached?”. Also check the boxes for “Submit Claims, Receive Electronic Remittances (if you are to receive your providers EOBs), and Receive Reports”
Each of the providers you bill for must complete the Railroad Medicare Provider Authorization Form to authorize your Billing Service to bill their claims electronically on their behalf using the Submitter ID/Name that you are applying for
You must fill out one of these forms for each of your providers
Medicare Electronic Data Interchange Enrollment Agreement
Please fill in the following section in this form:
Please complete Section C of this form
All of the providers that you will be submitting for must fill out one of these forms
Billing Services do not need to fill out this form.
Provider Authorization Form
The Railroad Medicare Provider Authorization Form is only for Providers using a Billing Service.
Providers who wish to authorize a Billing Service the authority to submit claims electronically would fill out this form, if not please skip.
Indicate the type of service(s) you are authorizing the Submitter (billing service) to access
Enter the Provider's name for which the form is being completed
Note: The name must match the name submitted on the CMS 855 Medicare Enrollment Application
Please enter the Providers Tax ID
Please enter the Providers email address for all EDI notifications
List the Providers PTAN, a seperate Provider Authorization form is required for each PTAN
Enter the Providers NPI
List the name and title of the person Palmetto will contact for questions regarding this form
Enter the demographic information of the Provider
Enter the name of the Submitter you are authorizing (billing service)
The Provider must sign and date the application
Submitting your Forms
It is recommended that you keep a copy of all the forms you will be submitting for your records.
Submit the enrollment forms reflecting original signatures to:
It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.
Waiting for a Response
Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take up to twenty days from the date of receipt.
After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after twenty days, contact the Technology Support Center toll-free at 1-888-355-9165.
Once you have received your Submitter ID and password from Palmetto GBA, please call the Claimshuttle Support Team at 602-439-2525 and set an appointment for a Mailbox setup and Test Transmission to Palmetto.
Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.