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Web Content Viewer (JSR 286)

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Enrollment

Web Content Viewer (JSR 286)

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Submit an Initial Enrollment Application

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Submit an Initial Enrollment Application

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Submit an Initial Enrollment Application


Best Practices for Submitting an Initial Enrollment Application:

  1. Take advantage of PECOS to complete your Enrollment Application.
  2. If you choose not to e-sign, remember to mail the signed and dated certification statements.
  3. Be sure to pay the application fee or submit a hardship request.
  4. If you are mailing in your application, verify that you are using the correct version of the CMS-855 (07/11).
  5. If you are mailing in your application, verify that you are using the correct version of the CMS-588 (05/10).
  6. Ensure that your application is completed, signed and that all supporting documentation is included.
  7. Ensure that the Legal Business Name entered in section 2 matches the name located on your IRS tax documentation.
  8. Respond quickly to any request for additional information or changes required to process your application.
Last Modified: 9/15/14

Learn About PECOS Web! New Provider Center

J6 Mailing Address:

National Government Services, Inc.

P.O. Box 6474 | Indianapolis, IN 46206-6474

JK Mailing Address:

National Government Services, Inc.

P.O. Box 7149 | Indianapolis, IN 46207-7149

Contact Enrollment:

J6: 855-834-5596

JK: 855-593-8047

Web Content Viewer (JSR 286)

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Web Content Viewer (JSR 286)

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