JM Part A EDI Enrollment

Please select the appropriate form:

NOTE:  For Virginia and West Virginia Providers -
Palmetto GBA has subcontracted with Wellpoint Federal (formerly National Government Services) to continue to support
electronic claim submission for your state. Please contact the Wellpoint Federal Helpdesk at 855-696-0705.

Enroll in EDI or make changes to an existing EDI Enrollment
EDI Online Enrollment Form

Attest relationship with a 3rd party entity to exchange ANSI X12 270/271 eligibility transactions
HETS Provider Attestation