I Am a Provider and “I Want to Connect Directly to the Part A FISS/DDE System”

This selection will prompt you to complete the Logon Request Form.

This option is for providers who need to request, modify, reinstate, or add additional access to the Part A FISS DDE system. Follow the steps outlined below to connect to FISS/DDE.

Step 1. Provider Information

Complete the following fields as it applies to the provider of services:

• Provider Name - Enter name EXACTLY as it was approved in section 2 of the CMS-855/PECOS enrollment applications.
• Provider/Facility Physical Address- Enter the physical or corporate address EXACTLY as approved in section 4 of the CMS-855/PECOS enrollment application.
• Contact First and Last Name - Enter name of the contact within the provider/facility office that will be the authorized contact for any logon IDs requested.
• Title - Enter the title of the contact person within the provider/facility office.
• Email Address - Enter the email address of the authorized contact for the provider.
• Telephone Number - Enter the provider/facility telephone number to their office.

Step 2. PTAN/NPI Information

If there’s one PTAN/NPI combination to include, then select “I have one PTAN/NPIs” tab.

Next, complete the following fields as it applies to the provider of services in the PTAN/NPI Information section:

• Primary PTAN - Enter the provider’s primary PTAN.
• Primary NPI - Enter the provider’s primary NPI.
• Provider/Facility Name - Enter the name EXACTLY as it was approved in section 2 of the CMS-855/PECOS enrollment application.
• Provider/Facility Address - Enter the physical or corporate address EXACTLY as approved in section 4 of the CMS-855/PECOS enrollment application.
  • If this is the same information entered in the “Provider Information” section check the box at the top of this section “Address is same as listed above”.
  • If the provider/facility office location is not the same as their corporate or primary location enter the provider/facility’s EXACT secondary location address as approved in section 4 of the CMS-855/PECOS Enrollment Application.

If there’s multiple PTAN/NPI numbers to include, then select “I have multiple PTAN/NPIs” tab.

• You can enter up to 100 PTAN/NPI combinations.
• They must all be for the same Medicare Contractor Code.
• They must all have the same Authorized or Delegated official.
• You must download and complete the supplied template.
• Once completed you must upload the template.

Step 3. Operators List

This section is completed with the operator’s information.

If there is one Operator Request the select the applicable action type for the request from the “Action” drop-down box.

Any additional action types for the same Operator will require an additional form to be completed.

Actions provided in the drop-down box:

• Add PTAN(s) – Add PTAN(s) to an ID that currently has access to the FISS region the PTAN(s) are assigned to.
• Change Operator Access – Update access level; either Inquiry or Inquiry/Update can be selected.
• Add Region (Dual Access) – Add an additional region of FISS access to an ID that is currently active.
• Delete Logon ID – to delete the Logon ID from the selected region.
• Delete PTAN(s) – Delete only specific PTAN(s), while leaving the Logon ID active.
• Name Update – Update username based on marriage, divorce, etc.; cannot change name to a new user.
• New Logon ID – Assign a new user a Logon ID (previously assigned inactive Logon IDs will need to be reinstated).
• Reinstate Logon ID – User has an existing Logon ID that is currently inactive.
• Change PIN – JM users only; user has the ability to change the four-digit numeric PIN currently on file.
• Update Contact – Update the Authorized contact on file.

Note: If the user has access to multiple contract codes, only the contract code selected on the form will be deleted from their access. If the user only has access to the contract code selected on the form, the ID will be deleted entirely.

Note: Only fields specific to the action selected will display.

• Operator First and Last Name – Enter the first name, middle initial and last name of the operator who will be accessing the FISS/DDE system.
  • Note: The middle initial is not a required field. If entering the middle initial, do not use X for the middle initial unless it actually is the middle initial.
• Telephone Number/Extension – Enter the direct telephone number and extension of the user.
• Email – Enter the direct email address of the user.
• Logon ID – This is the seven-digit Logon ID assigned to the user.
  • two alpha, five numeric (XX11111) or three alpha, four numeric (XXX1111)
• Operator Access – Choose either Inquiry or Inquiry/Update from the drop-down
  • “Inquiry” gives the ability to check status but not make changes.
  • “Inquiry/Update” gives the user the ability to check eligibility and make changes, such as sending or correcting a claim.

If there’s multiple Operators to include, then select “I have multiple Operator Requests”.

• You can add up to 25 operators who are requesting the same access per form.
• You must download and complete the supplied template.
• Once completed you must upload the template.

Step 4. Operating Information

Select the Network Service Vendor that will be providing your connectivity to NGS in the Network Service Vendor drop-down box.

The “Operating as” field will auto populate.

What is a Network Service Vendor?

The approved NSV that provides access to the National Government Services EDI gateway that you have a service agreement with (only required when the action Obtain or Update TPID is selected in Section I).

Step 5. Offshore Provider Information

Select “Yes” or “No” to indicate whether you or your organization uses one or more business entities that work outside the United States or US Territories to access the NGSConnex Provider Portal.

If “Yes” is selected complete the additional questions/information:

Step 6. Authorized Signature

Review the Terms and Conditions and check the box “I agree to the terms and conditions above”.

• Be sure to note, the requirements for who may sign the documents. The person signing the forms must be listed as an Authorized or Delegated Official in section 5/6 of the CMS-855/PECOS. The signature must be spelled EXACTLY as submitted on the in section 5/6 of the CMS-855/PECOS, and include the first and last name, as well as hyphenated names, suffixes, and middle names/initials.

Next, scroll down and complete the “signature name” and “title” fields and click the “submit” button.

Once completed, the EDI Enrollment Complete screen will display.

This screen will provide the PID information. You will also have the option to print the packet, finish and exit, or start a new packet. With printing, you are able to print to PDF which will allow you to save a copy of the packet or select the appropriate printer to obtain a paper copy.

Revised 10/18/2023