TriWest VACCN Regions 4 & 5 Palmetto GBA
Please follow the Enrollment Instructions below to become an electronic submitter to Palmetto GBA for your TriWest Region 4 & 5 claims. Please Note: this is only for claims that need to be sent to Payer ID TWVACCN. For TriCare West claim submission, which is Payer ID 99726, please review the instructions found on this page instead: http://www.solace-emc.com/tricare-west-palmetto-gba
The following documents are required enrollment documents that must be completed, signed and returned to the PGBA office prior to initiation of electronic claims submission or inquiry. you must either call them at 1-800-259-0264 option 1, or email them to request they send you these forms: [email protected]
1. PGBA, LLC VACCN Electronic Trading Partner Agreement
2. PGBA, LLC VACCN EDIG Trading Partner Enrollment Form
(Billing Services please contact Palmetto directly for the forms and instructions on how to complete them.)
If you have any questions regarding any of the documents in this package, please phone the PGBA EDI Technology Support Center at 1-800-259-0264 option 1.
Our Vendor Information
| Vendor Name - AXIOM Systems, Inc. |
| Contact - EDI Team |
| Vendor Code - N/A |
| Phone - 602-439-2525 |
| Fax - 602-439-0808 |
| Address - 241 East 4th Street, Suite 200 Frederick, MD 21701 |
| Software Name - SolAce EMC |
| E-mail - [email protected] |
PGBA, LLC VACCN Electronic Trading Partner Agreement
- Please leave the Agreement Number line blank
- Enter today’s date and your Business/Practice or Provider name in the first paragraph (You are the Trading Partner)
- Please complete section 9.1 on page 13 with your information (This tells PGBA who they should send notices to)
- Complete the Trading Partner section on the left side of page 16
- Complete Exhibit A
- Enter your information in the Trading Partner section
- Enter the software vendor information provided above in the Vendor information table. For AXIOM’s Tax ID please call us at 602-439-2525
- If you are a provider using a Billing Service, please enter the Billing Services information in the Billing Service Information section
- Please also make sure you also contact Palmetto directly to inquire if any additional forms are required
- On Exhibit A Page 2 Please Write in under Means of Electronic Access " Secure FTP" and "Will use AXIOM Systems Inc's IP and Certificate"
EDIG Trading Partner Enrollment Form
- Enter today’s date
- New applicants, please select “New Trading Partner ID”
- Complete the Trading Partner Name field with your Business/Practice or Provider name
- Leave the Trading Partner ID line blank if you are applying for a new ID and fill in your Tax ID in the Tax ID line
- For Type of Business select either Institutional or Professional
- If you are a Billing Service, please choose Billing Service
- Please also make sure to contact them to see if any additional forms are required
- For Line of Business, please choose “VA CCN”
- Enter today’s date for the start date and leave the end date blank
- Compression: choose PKZIP
- Protocol: choose Secure FTP ( on the left in the blank area write in "will use AXIOM Systems Inc's IP and Certificate" )
- Complete your address and contact information.
- For Transactions, choose:
- ASC X12N 835 for Electronic Remits (EOB's)
- ASC X12N 837I for Institutional, or
- ASC X12N 837P for Professional
- For every transaction checked, provide an average number of transactions submitted weekly
- For Vendor’s information enter: AXIOM Systems, Inc.
- Address: 241 East 4th Street, Suite 200 Frederick, MD 21701
- Transactions: 837P-5010 (for professional claims) and/or 837I-5010 (for institutional claims)
- Complete the Customers Information section with your information
- Leave the last page blank
Submitting your Forms
It is recommended that you keep a copy of all the forms you will be submitting for your records. Email the forms to the following addresses:
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 approximately two to three weeks 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 three weeks, contact the PGBA, LLC EDI Technology Support Center at 1-800-259-0264.
Mailbox Set Up
Once you have received your Submitter ID and Password from PGBA, LLC, please call the SolAce Support Team at 602-439-2525 and set an appointment for a Mailbox setup.
customer Testimonial
From our customers
I am very pleased with our SolAce billing software and how easy it is to navigate. They have a great team who can train you to do billing even if you don’t have billing experience. Special thanks to Cathy, Gigi, and Skyler who always helps me out every time I have issues.
SolAce is awesome software. I absolutely LOVE it. For over three years I have used this software daily for multiple long term care facilities to submit claims to various MACs, Medicaid, and Medicare Advantage and Supplemental Insurance carriers. It is convenient, simple to use and far less costly than any Clearing House software I had explored. The ability to import from my Practice Management Software and Therapy Providers has reduced any RTP claims edits and denials are a thing of the past. Customer Support is “Johnny on the spot”, but terrific as they may be, it gets better - RARELY do I need to call. LOVE IT, LOVE IT, AND LOVE IT.
I think our medical office was one of the first to use SolAce in the mid 1990’s and we are still using it today for all of our electronic billing because it works ! It was simple for our staff to learn and it integrated easily with our accounting/billing program. It has been especially nice to know that the Axiom staff is there when Medicare changes something and they are right on it. They made the 5010 change a simple process plus made educational seminars available to us. Thank you to all the Axiom/ Ivertex professionals who have helped us for the last 15+ years.
SolAce has been a valuable tool that has been a life saver for my billing service for years. It has allowed me to bill professional and institutional claims with ease. Customer service @ SolAce is top rated in my opinion. The SolAce product is very user friendly and affordable. Thank you SolAce team for a great product.
Easy to use, Customer support has always been excellent, Thanks SolAce Team.
I am a new client and was having a tough time getting everything set up just right. I had to make calls to CEDI and when I called back the rep I spoke with prior even helped the 2nd rep to make sure I got all the info I needed. They definitely work as a team. Within a short period of time they had my system up and running. I never could've done it without them.
Awesome customer service every time!
I can't tell you how wonderful it is to work with your agency. They are courteous, knowledgeable,friendly, and a joy to work with - I can't say enough. Thank you!!
The service was very good. Phone answered promptly even though it was around 6 p.m. my time. Very courteous and helpful. So far I have had really good experiences with your support team.
The follow-up is outstanding - whenever there is an issue I am contacted to be sure that all is working well and to my satisfaction.
Everyone in your company is very helpful and pleasant, and they always have the quickest response time on fixing the situation.
Tech was very helpful, very patient and very professional. She knew of the issue quickly and stayed at hand until issue was resolved. Very satisifed with the service.
