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** Provider Action Required** North Carolina Medicare Part B move to Palmetto Jurisdiction 11

Effective May 28, 2011, North Carolina Medicare Part B providers will be transitioned to Palmetto GBA.  Palmetto GBA is sending out Welcome letters to all existing Medicare providers informing them that a new EDI Agreement will be required and the website location of the form.

This re-enrollment form should be completed based on how you have credentialed with this payer, as a group or individual.  Only one form is required if you are submitting as a group.

Please complete, sign, and return this form to Gateway EDI for processing.
 
Gateway EDI will complete the Clearinghouse portion of this enrollment when your form is processed.  To avoid an interruption in claim processing, please return this form to the below address no later than April 30, 2011.

Gateway EDI
Attn:  NC Medicare Part B
501 N Broadway, 3rd Floor
St. Louis, MO 63102

 
Link to Required Form: http://www.palmettogba.com/Palmetto/Providers.Nsf/files/EDI_Enroll_J11B_Agree.pdf/$File/EDI_Enroll_J11B_Agree.pdf

by KareoSupport