EDI Onboarding and Connectivity

The Customer Service Front End System (CSFES) receives and processes Medicare Part C, and Medicare Part D data as well as data from plans participating in the Medicare Medicaid Financial Alignment Initiative. To ensure proper exchange of this data, organizations must establish a secure connection with the Centers for Medicare and Medicaid Services (CMS) systems.

Organizations must contact a CMS approved Network Service Vendor (NSV) to establish connectivity with Palmetto GBA’s secure, encrypted network. Click here for the list of approved NSVs.

Organizations with less than 100,000 enrolled beneficiaries are able to establish connectivity directly with CMS. For assistance in establishing this connectivity, contact the Medicare Advantage Prescription Drug (MAPD) Help Desk at 1-800-927-8069 or by email at MAPDHELP@cms.hhs.gov.

Once connectivity has been established there are onboarding forms that must be completed.

Electronic Data Interchange (EDI) Agreement
Submitter/Receiver ID Application
Submitter Authorization Form (for plans utilizing a Third Party Submitter)
Connect:Direct Form(s)

A description of each form can be found by clicking the applicable link from the list provided below:

2020 PDE Certification Package 2021 PDE Certification Package 2022 PDE Certification Package Medicare Advantage and Part D Communications Handbook Approved Network Service Vendors Encounter Data Certification Requirements MMP Connect:Direct Form Submitter Authorization Form Encounter Connect:Direct Form PDE Connect:Direct Form RAPS Connect:Direct Form Electronic Data Interchange (EDI) Agreement EDI Onboarding Forms Submitter/Receiver ID Application