Submit Enrollment Application

Verify and Manage Signature(s)

Verify signatures on all application(s) submitted including applications that were “Return for Corrections”, by returning to the enrollment box in PECOS.

Important: The reassignments are viewed by selecting “View/Manage Reassignments” in the enrollment box.

When the “Manage Signature” button appears, select to follow up if the signature status is pending.  (Either resend the email to signer for e-signature or upload a (PDF, TIFF) signed and dated certification statement) Printable Certification statements are located by selecting the “View” button.

We recommend signatures being completed the same day of submission to prevent delay in processing.

View of the enrollment box with the Manage Signature button, not all inclusive:

Image of the PECOS Existing Enrollments page. The Manage Signature button is shown in the Action column.
 

PECOS image of New Enrollments information. The Manage Signatures button is located on the right hand side of the image under the View button.

View of the pending reassignment applications after selecting “View/Manage Reassignment” from the enrollment box with the Manage Signature button, not all inclusive:

PECOS image of the View/Manage Reassignments page. The Manage Signature button is located under the title Action.

Posted 10/30/2023

Helpful Resources

Check Provider Enrollment Application Status
Log Into PECOS
Pay Application Fee

J6 Mailing Address:

National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475

Interactive Voice Response:

877-908-9499

Contact Enrollment:

877-908-8476

Hours Available:

Monday–Friday
8:00 a.m.–4:00 p.m. CT

Form(s) you'll need:

Enrollment Forms

Helpful Resources

Check Provider Enrollment Application Status
Log Into PECOS
Pay Application Fee

JK Mailing Address:

National Government Services, Inc.
P.O. Box 7149
Indianapolis, IN 46207-7149

Interactive Voice Response:

877-869-6504

Contact Enrollment:

888-379-3807

Hours Available:

Monday–Friday
8:00 a.m.–4:00 p.m. ET

Form(s) you'll need:

Enrollment Forms