Career | Calendar | Shopping Cart | Sign In
Attention All Home Health Agencies(HHA)
License/Accreditation Verification Required
Effective April 12,2010 Palmetto GBA is requesting verification of license and/or accreditation documentation by April 30, 2010
Please submit a copy of your HHA State License OR Accreditation documentation by mail OR fax with the attached coversheet by April 30, 2010 to the following address.
Palmetto GBA
                                Part A Provider Enrollment (AG-330)
    P.O. Box 100144
        Columbia, SC 29202
           FAX: 803-763-2030
Failure to submit valid state license and /or accreditation documentation by the requested date will result in your Medicare billing privileges being revoked.
Please direct any questions you may have regarding this process to our Provider Contact Center at 866-801-5301


Click Here to Download form 
or contact our office at (713) 995-8146  to have form faxed if you have problems with downloading