Palmetto GBA

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Please reach out to your CSM to confirm once you have completed the required attestation. If you have not completed and confirmed completion of all required attestations by May 11, you will be unable to run Medicare checks.

Step 1: Open the Palmetto HETS Provider Attestation page

1. Navigate to the relevant link below depending on which MAC jurisdiction you are assigned to:
   1. Jurisdiction JJ Part B (AL, GA, TN)
   2. Jurisdiction JM Part B (NC, SC, VA, WV)

Step 2: Enter provider and trading partner information

On the Home screen, enter the following:

1. PTAN
2. NPI
3. Trading Partner Unique ID: 274B
4. Click Lookup

Step 3: Add provider details

If no existing relationship is found, complete the Add Provider section:

1. Start Date
   • Enter today’s date or a future date.
2. End Date
   • Leave blank to keep the relationship active.
3. Provider Email Address
   • This will be the primary contact email.
4. Alternate Email Address
   • Optional.
5. Answer Yes or No to the offshore organization question.

Click Add.

(Screenshot: Add Provider form)

Step 4: Confirm successful attestation

• A message will appear indicating the provider attestation was added successfully.
• Click Back to Home if you need to add another provider or update an existing entry.

Important notes

• Attestation is required per NPI.
• The attestation must be completed by the provider or authorized delegated official.
• Clearinghouses or billing services should not complete this form on behalf of the provider.

Summary

1. Open the Palmetto HETS Provider Attestation tool
2. Enter PTAN, NPI, and Stedi’s Trading Partner Unique ID
3. Add provider details and submit
4. Confirm successful attestation

This completes your CMS eligibility attestation with Palmetto GBA.

Additional Information:

• PGBA HETS EDI Enrollment User Guide