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Jurisdiction 11 Part A
Provider Enrollment

Provider Enrollment Resources:

  • Enroll or change your facility’s Medicare information online: https://pecos.cms.hhs.gov (print, sign and date the two-page Certification Statement and mail the Certification Statement and all supporting paper documentation to Palmetto GBA within seven days of electronic submission)
  • Enrollment Application Status Lookup 
  • CMS Fact Sheet (PDF, 1.44 MB): enrollment information for all institutional providers
  • Access the CMS-855A form (PDF, 784 KB). Then print, sign and mail it to Palmetto GBA.
  • Mail paper applications to:
      Palmetto GBA
      Part A Provider Enrollment (AG-331)
      2300 Springdale Drive, BLDG One
      Camden, SC 29020
  • Access the status of your CMS-855 application
  • Call the Provider Contact Center at 866-830-3455 for additional assistance

Select a Topic:


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Revalidation Initiative: Frequently Asked Questions (FAQs)04/11/2013
List of Providers sent a Revalidation Request03/12/2013
Part A Electronic Funds Transfer (EFT) Enrollment Packet01/30/2013
Medicare Provider Enrollment Application Fee for Calendar Year (CY) 201312/12/2012
Implementation of Provider Enrollment Provisions in CMS-6028-FC12/04/2012
Revalidation Checklist10/07/2012
Provider Transaction Access Number (PTAN) Issue07/30/2012
Medicare Physicians and Non-Physician Practitioners: Protecting Your Privacy, Protecting Your Medicare Enrollment Record07/01/2012
Were You Sent a Request to Revalidate Your Medicare Enrollment?06/12/2012
Major Improvements: Internet-based PECOS05/15/2012
CMS 855A Medicare Enrollment ApplicationOpen in New Window05/11/2012
Sign Your Medicare Enrollment Application Electronically04/30/2012
Sample Revalidation Letter01/19/2012
Guidance on Completing the CMS-855A Enrollment Form11/22/2011
Important Information on the Revalidation of Medicare Provider Enrollment11/08/2011
Implementation of Provider Enrollment Provisions in CMS-6028-FC11/03/2011
Payment of the Medicare Enrollment Application Fee for Institutional Providers10/27/2011
Submitting Your Medicare Enrollment ApplicationOpen in New Window07/07/2011
Effective Date of Certified Provider or Supplier Agreement or Approval04/04/2011
Provider-Based Attestation Statement03/22/2011
Provider-Based: General Information09/24/2010
Provider-Based: Off-Campus Outpatient Coinsurance Notice09/24/2010
Provider-Based: Terms and Definitions09/24/2010
Internet-Based Medicare Enrollment Now Available to Provider and Supplier Organizations in All States and in the District of Columbia01/01/2010

 

last updated on 6/01/2013
ver 1.0.42