- Determine if you Will Use PECOS or Paper to Revalidate
- Submit Revalidation Using PECOS
- Submit Revalidation Using Paper
- Clinics/Group Practices and Other Suppliers
- Physicians and Nonphysician Practitioners in Private Practice (Sole Owner or Sole Proprietor) With or Without any Reassigned Benefits
- Physicians and Nonphysician Practitioners that Reassign All Benefits
- Electronic Funds Transfer Agreement
- Supporting Documents
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:
View of the pending reassignment applications after selecting “View/Manage Reassignment” from the enrollment box with the Manage Signature button, not all inclusive:
Reviewed 7/30/2024
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:
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: