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Palmetto dde enrollment form 2025

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The document outlines the enrollment process for Direct Data Entry (DDE) and Electronic Data Interchange (EDI) for Medicare Part A providers through Palmetto GBA. It includes instructions for completing the DDE Enrollment Form, which requires individual user IDs for accessing claims processing and eligibility information. The document details the necessary fields to be filled out, actions that can be requested (such as requesting new IDs or deleting existing ones), and submission guidelines. Additionally, it provides information on how to communicate electronically with Palmetto GBA, including modes of communication and requirements for submitting claims and receiving reports.

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Click ‘Get Form’ to open the palmetto dde enrollment form in the editor.
Begin by filling out the 'Line of Business Information' section. Indicate the specific line of business and state for which you will be transmitting.
Enter your 'Submitter ID' if available; otherwise, leave it blank for new applicants as it will be assigned by Palmetto GBA.
Complete the 'Entity Name' field with the name of your organization or provider requesting the DDE ID.
Provide contact details including 'EDI Contact Person', phone number, fax number, and mailing address to ensure effective communication.
List each provider requiring access under 'Provider Name', along with their PTAN and NPI numbers. If more space is needed, attach a separate list.
Select the appropriate action requested from options such as 'Requesting New ID' or 'Delete Existing ID'.
Review all entered information for accuracy before submitting. Retain a copy for your records.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the DDE portal?

DDE is a real-time FISS application giving providers interactive access for inquiries, claims entry and correction purposes.

How do I contact Palmetto GBA provider enrollment?

Call 855-696-0705 (Toll Free) Our Provider Contact Center representatives are here to assist you with general inquires, provider enrollment, EDI, eServices, and more.

What is a DDE link?

Windows provides several methods for transferring data between applications. One method is to use the Dynamic Data Exchange (DDE) protocol. The DDE protocol is a set of messages and guidelines. It sends messages between applications that share data and uses shared memory to exchange data between applications.

What is a DDE login?

DDE User ID numbers are assigned to individuals at each facility who utilize the DDE system. Each user must have an individual DDE User ID. One ID can access multiple provider numbers.

What is DDE access?

DDE is a real-time Fiscal Intermediary Shared System (FISS) application giving providers interactive access for inquiries, claims entry and correction purposes. Functions include: Eligibility.

dde enrollment form

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What is the phone number for Palmetto GBA EDI?

Please contact the Palmetto GBA Provider Contact Center toll-free at 8883559165 for EDI-related assistance. You may also email us by clicking on Contact Us at the top of this page.

What is Medicare DDE used for?

DDE is designed for Medicare Part A providers. DDE will allow you to perform the following functions; claim entry, claim correction, claim status, claim adjustments, and inquiries.