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Submit an Initial Enrollment Application
Submit an Initial Enrollment Application

Submit an Initial Enrollment Application


Best Practices for Submitting an Initial Enrollment Application:

  • Take advantage of the internet-based PECOS to complete your enrollment application
  • PECOS submissions, either e-sign or upload (PDF or TIFF) the signed and dated certification statement
  • Paper submission, ensure the application is signed and dated by an authorized/delegated official
  • Ensure that your application is complete and all supporting documentation is included
  • Be sure to pay the application fee or submit a hardship request
  • If you are mailing in your application, verify that you are using the correct version of the CMS-855 and CMS-588
  • Ensure that the Legal Business Name entered matches the name located on your IRS tax document
  • Respond quickly to any request for additional information or changes required to process your application
Last Modified: 11/2/20

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

Available by phone Monday-Friday*
JK: 8:00 a.m.-4:00 p.m. ET
J6: 8:00 a.m.-4:00 p.m. CT
J6: 9:00 a.m.-5:00 p.m. ET

*Closed for training on the 2nd and 4th Friday of the month
12:00 p.m.-4:00 p.m. ET
11:00 a.m.-3:00 p.m. CT

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