- Electronic Data Interchange (EDI)
- EDI Enrollment
- EDI Tools
- Frequently Asked Questions
- Software and Technical Specifications
Online ERA /ERN and GPNet Report Restore Form
Palmetto GBA Medicare Electronic Data Interchange (EDI) is pleased to offer the Online ERA Report Restore Form for the restoration of electronic remittance notices/advices (ERNs/ERAs) and GPNet Response Reports (999 & 277CA).
ERNs/ERAs and GPNet Response Reports are available for restore 20 business days prior to today’s date. Remit files and reports will be restored to your electronic submitter mailbox. The requestor will receive a confirmation by email.
Note: If you receive your Response Reports and/or Remit files from a clearinghouse, please confer with them prior to completing a request. Restorations will include all providers linked to the requested Submitter/Receiver ID.
Please complete all fields in the attached form. Incomplete forms will not be processed. The form fields are described below:
|Form Field Name||Instructions for Field Completion|
|Choose Medicare Contract||Left click on arrow and select appropriate contract|
|Submitter ID||The ID that was issued by Palmetto GBA upon completion of your EDI application form. This ID may also be referred to as a Receiver ID.|
|Submitter Name||Enter the name of the entity which was assigned the Submitter ID/Receiver ID|
Click on arrow and select Restore Option ERNS or Reports
|Check/EFT Number (Will only appear when ERNs is selected as Restore Option)||Enter the Check/EFT number to be restored|
|ISA 13 File ID
(Will only appear when Reports is selected as Restore Option)
|Enter the File ID to be restored. This will appear in the ISA13 of the 837 file submitted.|
|Date||Left click in field and a calendar will appear. Select the date to restore.|
|Email Address||Enter the email address. The confirmation will be sent to this address.|
|Requestor Name||Enter the name of the person submitting this request|
|Contact Phone Number||Enter the area code and phone number of requestor listed above|
Do not attempt to combine GPNet Response Report requests and ERN/ERA requests. They should be separate requests.
Access the Online ERA Report Restore Form.