Skip to Main Content
 
 
 
Web Content Viewer

CHANGE EXISTING PROVIDER ENROLLMENT INFORMATION

Web Content Viewer
Web Content Viewer

Sign and Submit the Application(s)

In order to send your application, after resolving all errors, you must select “Begin Submission” which is available from any of the tabs (Topic View, Fast Track View, Error/Warning Check).

Instructions for signing and submitting the applications(s):

  • Proceed with the electronic signature or upload certification process.
    • If electronic method selected:
      • You will either be prompted to sign electronically or an email will be generated for the individual provider or the authorized/delegated official with instructions to electronically sign.
    • If upload method selected:
      • Print the hardcopy certification statement
      • Obtain original signature and enter current date
      • Save document as a .pdf or .tiff
      • Upload the signed certification statement
        Important: A certification statement should never be uploaded to the required and/or supporting documentation topic section.
    • Read and answer attestation question when applicable.
    • Verify National Government Services as your contractor.
    • Scroll to the bottom and select “Complete Submission.”  

Mail any supporting documents that were unable to be uploaded before submission, indicate the case or tracking number from acknowledgement notice.

The application percentage will then display as 100% complete and a confirmation from customerservice-donotreply@cms.hhs.gov will be sent to the email address of the contact person containing the tracking number for your application.  

Note: Add the above email address to your safe senders list and routinely verify spam or junk email folders.

Sign and Submit the Application(s)
Web Content Viewer
Complementary Content