EDI Enrollment Status Messages and Descriptions APPROVALS Approved Claims Approved Remits Approved - Claims/Remits Approved Provider Approved DDE/PPTN Approved -New vendor Approved - Production Completed - Updated submitter address Approved - Duplicate request Completed for Online DDE Requests GENERAL Pending Process Work Rejected Invalid EDI Enrollment Rejected Outdated Rejected Duplicate Request Rejected Altered Rejected Multiple PTANs (Provider Numbers)/NPIs listed on request Rejected Missing Group PTAN (Group ID) on all Group PTAN (Provider ID) on all (Provider ID) on all (Provider ID) on all Rejected Missing NPI on all Approvals Status Description The provider was setup with the requestor for electronic claims submission. Electronic claims may be submitted the following day after the date listed in the Status Date field. Electronic Remittance (ERA) was setup with the requested Receiver. The provider was setup for both electronic claims submission and electronic remittance with the requestor. Electronic claims may be submitted the following day after the date listed in the Status Date field. EDI Enrollment has been placed on file with EDI Operations for the PTAN/provider. The provider/entity was setup for Direct Data Entry and/or Professional Provider Telecommunications Network Access. Ids will be returned to the site. The EDI form was processed and a vendor testing ID was generated and returned to the address on the form. The test claims were verified and the software vendor will be added to the approved vendor listing. The request to update a submitter address was completed. EDI Operations has previously processed forms with the same transactions selected. DDE ID(s) are being processed for your site and will be mailed once assigned. General Status Description Palmetto GBA has received your EDI Enrollment forms and the forms are pending. Palmetto GBA has received your EDI Enrollment forms and the forms are pending. The EDI Enrollment forms that were submitted are not valid for the Line of Business selected. Please go to www.palmettogba.com/medicare, select your Line of Business, then EDI, then Enrollment. You can select the EDI Enrollment Packet to obtain the most recent EDI Enrollment forms. The EDI Enrollment forms that were submitted are no longer valid documents. Please go to www.palmettogba.com/medicare, select your Line of Business, then EDI, then Enrollment. You can select the EDI Enrollment Packet to obtain the most recent EDI Enrollment forms. EDI Operations has previously rejected forms with the same transactions selected. Please correct and resubmit. Palmetto GBA EDI Enrollment forms have been altered and rejected. Please resubmit valid Palmetto GBA EDI Enrollment forms. The EDI Enrollment forms were submitted with multiple PTANS/NPIs. Please correct and Note: If the provider is a member of a group, please list the group PTAN, group NPI and Group Name on all documents. Provider number listed is a member of a group. Please resubmit all EDI forms and include the Group PTAN (Group ID) associated with this provider number (PTAN). If you do not have this information, please contact the Provider Enrollment department for your Business. Note: If the provider is a member of a group, please list the group PTAN, group NPI and Group Name on all Line of documents. The Group PTAN (Provider ID) on all forms is invalid. Please resubmit all forms with the correct PTAN (Provider ID). If you do not have this information, please contact the The PTAN (Provider ID) is missing on all forms. Please correct and The PTAN (Provider ID) on all forms is invalid. Please resubmit all forms with the correct PTAN (Provider ID). If you do not have this information, please contact the Provider The NPI is missing on all forms. Please correct and
GENERAL all Rejected Invalid Address on all EDI Provider Name on all General Status Description The NPI number on all forms is not on the NPI Crosswalk with the legacy PTAN. Please resubmit all forms with a valid NPI. The Provider s Address on all forms is invalid. If the address on the forms is correct, please contact the Provider Enrollment department for your Line of Business to update. The Provider s Name is invalid on all forms. If the name on the forms is correct, please contact the Provider Enrollment department for your Line of Business to update. EDI APPLICATION Rejected Missing EDI Rejected - Missing Action Requested on EDI Rejected Incorrect Action Requested on EDI ID on EDI ID on EDI Rejected Missing Receiver ID on EDI Rejected Invalid Receiver ID on EDI Name on EDI Rejected Invalid Submitter Name on EDI Rejected Missing Owner Name on EDI Address on EDI Address on EDI Rejected Missing Type of Submitter on EDI Rejected Missing EDI Contact Person on EDI Name on EDI name on EDI (Provider ID) on EDI (Provider ID) on the EDI EDI Status Description The EDI Enrollment were submitted but the EDI was not included. You must submit a completed EDI when submitting additional EDI forms. Please The Action Requested was not selected on the EDI. The EDI instructions are available in the EDI Enrollment packet. Please correct and The Action Requested selected is not applicable to request. The option to Submit Claims was selected but the Submitter ID is missing on the EDI. Please correct and If you are requesting a Submitter ID, please select the correct Action Requested on the EDI form. The Submitter ID included on the EDI is invalid. Please resubmit with a valid Submitter ID. If you are requesting a Submitter ID, please select the correct Action Requested on the EDI form. The option to receive Electronic Remittances was selected but the ERN Receiver ID is missing on the EDI. If you are requesting an ERN Receiver ID, please select the correct Action Requested on the EDI form. The Receiver ID included on the EDI is invalid. Please resubmit with a valid Receiver ID. If you are requesting a Receiver ID, please select the correct Action Requested on the EDI form. The Submitter Name is missing on the EDI. Please correct and resubmit all forms. The Submitter Name on the EDI is invalid. Please correct and If the request is to change the Submitter Name, please select the correct Action Requested on the EDI and The Owner Name is missing on the EDI. Please correct and resubmit all forms. The Submitter Address is missing on the EDI. Please correct and The Submitter Address on the EDI is invalid. If this is a request to change the Submitter Address, please select the correct Action Requested on the EDI and The type of Submitter is missing on the EDI. Please correct and The EDI Contact Person is missing on the EDI. Please correct and The provider name is missing on the EDI. Please correct and resubmit. The Provider Name on the EDI is invalid. Please correct and resubmit all forms. If the name on the form(s) is correct, please contact the Provider Enrollment department for your Line of Business to update. The PTAN (Provider ID) is missing on the EDI. Please correct and The PTAN (Provider ID) on the EDI form is invalid. Please resubmit all forms with the correct PTAN (Provider ID). If you do not have this information, please contact the
EDI APPLICATION PTAN (Group ID) on EDI Rejected Missing NPI on EDI EDI Transaction Type on EDI Information on EDI EDI AGREEMENT Rejected - Missing EDI Enrollment Rejected - Incomplete EDI Name on EDI name on EDI Address on EDI Address on EDI Rejected Missing Original Signature on EDI (Provider ID) on EDI PTAN (Provider ID) on EDI PTAN (Group ID) on EDI Rejected Missing NPI on EDI EDI PROVIDER AUTHORIZATION FORM Rejected - Missing Provider Rejected - Missing Action Requested on Provider EDI Status Description Provider number listed is a member of a group. Please resubmit all EDI forms and include the Group PTAN (Group ID) associated with this provider number (PTAN). If you do not have this information, please contact the The NPI is missing on the EDI. Please correct and The NPI number on the EDI is not on the NPI Crosswalk with the legacy PTAN. Please resubmit the forms with a valid NPI. The transaction type was not selected. Please correct and The Provider section of the EDI was not completed. Please correct and EDI Status Description The EDI Enrollment were submitted but the EDI Enrollment was not included. Please resubmit the EDI, the three-page EDI Enrollment, and the Provider (if applicable). The EDI Enrollment signature page was submitted but the first two pages of the were not included. All three pages of the EDI Enrollment are required. Please The Provider Name is missing on the EDI. Please correct and resubmit. The Provider Name on the EDI is invalid. Please correct and resubmit all forms. If the name on the form(s) is correct, please contact the Provider Enrollment department for your Line of Business to update. The Provider s Address is missing on the EDI. Please correct and The Provider s Address on the EDI is invalid. If the address on the agreement is correct, please contact the Provider Enrollment department for your Line of Business to update. The EDI Enrollment was submitted but there was not an original signature included. Please resubmit all pages and include an original signature. The PTAN (Provider ID) is missing on the EDI. Please correct and The PTAN (Provider ID) on the EDI is invalid. Please resubmit all forms with the correct PTAN (Provider ID). If you do not have this information, please contact the Provider Enrollment department for your Line of Business. Provider number listed is a member of a group. Please resubmit all EDI forms and include the Group PTAN (Group ID) associated with this provider number (PTAN). If you do not have this information, please contact the Provider The NPI is missing on the EDI. Please correct and The NPI on the EDI is not on the NPI Crosswalk with the legacy PTAN. Please resubmit the forms with a valid NPI. Provider Status Description The EDI Enrollment were submitted but the Provider was not included. If a Billing Service or Clearinghouse is requesting linkage to a provider, the Provider must be submitted. Please resubmit the EDI, the three-page EDI Enrollment and the Provider. The Action Requested was not selected on the Provider. Please correct and
PROVIDER AUTHORIZATION FORM Name on Provider Name on Provider Address on Provider Authorization Address on Provider (Provider ID) on Provider (Provider ID) on Provider PTAN (Group ID) on Provider Rejected Missing NPI on Provider Provider Rejected Missing Name on Provider Rejected Invalid Name on Provider Rejected Missing Original Signature on Provider Name on Provider Authorization Name on Provider Authorization Provider Status Description The Provider Name is missing on the Provider. Please correct and resubmit. The Provider Name on the Provider is invalid. Please correct and If the name on the form(s) is correct, please contact the Provider Enrollment department for your Line of Business to update. The Provider s Address is missing on the Provider. Please correct and The Provider s Address on the Provider is invalid. If the address on the form is correct, please contact the Provider Enrollment department for your Line of Business to update. The PTAN (Provider ID) is missing on the Provider. Please correct and The PTAN (Provider ID) on the Provider is invalid. Please resubmit all forms with the correct PTAN (Provider ID). If you do not have this information, please contact the Provider Enrollment department for your Line of Business. Provider number listed is a member of a group. Please resubmit all EDI forms and include the Group PTAN (Group ID) associated with this provider number (PTAN). If you do not have this information, please contact the The NPI is missing on the Provider. Please correct and The NPI number on the Provider is not on the NPI Crosswalk with the legacy PTAN. Please resubmit the forms with a valid NPI. The Name is missing on the Provider. Please include the name of the contact person regarding the Provider and The Name listed is not a valid contact Name for the provider listed on the Provider. Please include a valid name of the contact person regarding the Provider and Note: The provider/practice name is not an acceptable. The Provider was submitted but there was not an original signature included. Please resubmit all pages and include an original signature. The Provider was submitted but the Submitter Name was not included. Please correct and The Submitter Name listed must be associated with the Submitter ID listed on the EDI. Please correct and SOFTWARE ORDER FORM Rejected Missing Software Order (Provider ID) on Software Order (Provider ID) on Software Order Rejected Missing NPI on Software Order Software Order Software Order Status Description The EDI Enrollment were submitted but the Software Order was not included. You must submit a completed Software Order when requesting software. Please The PTAN (Provider ID) is missing on the Software Order. Please correct and The PTAN (Provider ID) on the Software Order is invalid. Please resubmit all forms with the correct PTAN (Provider ID). If you do not have this information, please contact the Provider Enrollment department for your Line of Business. The NPI is missing on the Software Order. Please correct and resubmit all forms. The NPI on the Software Order is not on the NPI Crosswalk with the legacy PTAN. Please resubmit the forms with a valid NPI.
SOFTWARE ORDER FORM ID on Software Order ID on Software Order Name on Software Order Rejected Missing Contact Person on Software Order Address on Software Order ONLINE INQUIRY SERVICES FORM Rejected Missing Entity Name on Online Inquiry Services Rejected Missing Contact Person on Online Inquiry Services Rejected Missing Address on Online Inquiry Services Name on Online Inquiry Services Name on Online Inquiry Services (Provider ID) on Online Inquiry Services (Provider ID) on Online Inquiry Services PTAN (Group ID) on Online Inquiry Services Rejected Missing NPI on Online Inquiry Services Online Inquiry Services Rejected No valid DDE/PPTN Owner Name Software Order Status Description The option to Submit Claims was selected but the Submitter ID is missing on the EDI. Please correct and If you are requesting a Submitter ID, please select the correct Action Requested on the EDI form. The Submitter ID included on the EDI is invalid. Please resubmit with a valid Submitter ID. If you are requesting a Submitter ID, please select the correct Action Requested on the EDI form. The Submitter Name is missing on the Software Order. Please correct and The Contact Person is missing on the Software Order. Please correct and The Submitter Address is missing on the Software Order. Please correct and Online inquiry Services Status Description The entity name is missing on the Online Inquiry Services. Please correct and The Contact Person is missing on the Online Inquiry Services. Please correct and The Submitter Address is missing on the Online Inquiry Services. Please correct and The Provider Name is missing on the Online Inquiry Services. Please correct and resubmit. The Provider Name on the Online Inquiry Services is invalid. Please correct and If the name on the form(s) is correct, please contact the Provider Enrollment department for your Line of Business to update. The PTAN (Provider ID) is missing on the Online Inquiry Services. Please correct and The PTAN (Provider ID) on the Online Inquiry Services is invalid. Please resubmit all forms with the correct PTAN (Provider ID). If you do not have this information, please contact the Provider Enrollment department for your Line of Business. Provider number listed is a member of a group. Please resubmit all EDI forms and include the Group PTAN (Group ID) associated with this provider number (PTAN). If you do not have this information, please contact the Provider The NPI is missing on the Online Inquiry Services. Please correct and The NPI on the Online Inquiry Services is not on the NPI Crosswalk with the legacy PTAN. Please resubmit the forms with a valid NPI. The Online Inquiry Services form does not contain valid DDE/PPTN Owner Names on the form. Please correct and