National Payers

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:
https://www.palmettogba.com/palmetto/providers.nsf/files/EDI_RR_Enroll_App.pdf/$FILE/EDI_RR_Enroll_App.pdf

If you have any questions regarding any of the documents in this package, please phone the Palmetto GBA EDI Technology Support Center at 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.

Our Vendor Information

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 choose "Apply for New Reciever ID"
• In the section that follows please enter the following:
  • Today’s date
  • Your name or Business name in the Submitter Name line
    • New applicants may leave the Submitter ID and ERN ID’s blank
  • Please enter the name of your business owner
  • 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 “AXIOM Systems Inc.” and Vendor ID VR1158
  • For name of Network Service Vendor enter "ClaimShuttle by Axiom Systems"
  • 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:

Providers

• Please complete Section C of this form

Billing Services

• 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 separate Provider Authorization form is required for each PTAN
• Enter the Provider’s 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:

Fax: 803-382-2416

Email: [email protected]

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 business days from the date of receipt.

After processing, a confirmation will be sent to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after 20 business days, contact Palmetto EDI Technology Support Center at 888-355-9165.

Testing

Once you have received your Submitter ID and password from Palmetto, please call the SolAce 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.