Submit Enrollment Application

Instructions for Unfinished PECOS Enrollment Application(s)

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Instructions for Unfinished PECOS Enrollment Application(s)

Two acknowledgement notices are sent when submitting an enrollment application via PECOS. The contact person indicated on the PECOS enrollment will receive an email with a tracking number from customerservice-donotreply@cms.hhs.gov, once the application is submitted. An acknowledgement email with a case number from NGS-PE-Communications@elevancehealth.com will be sent when application is placed in workload.

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Instructions for Unfinished PECOS Application(s)

  • Enter user ID and password to sign into PECOS
  • My Associates
  • Scroll down under Existing Associates
  • “View Enrollment” for applicable enrollment record
  • Scroll down to applicable enrollment record with a tracking number and select “more options”
  • “Continue working on application” then “next page”
  • Complete unfinished Topics
  • “Begin Submission”
  • Proceed with the Electronic Signature or Upload (PDF or TIFF) Certification Process
  • Review and agree to Medicare regulations (Read and answer Attestation questions)
  • Verify National Government Services as your contractor
  • “Complete Submission” button must be clicked to finish application
  • Print your submission confirmation and tracking number

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Instructions for Application Status “Pending E-Signature”

Submitted Enrollment Application(s)

  • Enter user ID and password to sign into PECOS
  • Scroll down under Manage Signatures
  • Select “View and Sign”
  • Review and agree to Medicare regulations (Read and answer Attestation questions)
  • Select “Submit” to complete signature process

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Submitted Enrollment Application(s) on Behalf of an Individual or Group

  • Follow instructions above for the signee
    or
  • Look for the email (check spam/junk folder) from customerservice-donotreply@cms.hhs.gov and follow instructions.

Revised 10/25/2024

Helpful Resources

Check Provider Enrollment Application Status
Log Into PECOS

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

Helpful Resources

Check Provider Enrollment Application Status
Log Into PECOS

J6 Mailing Address:

National Government Services, Inc.
P.O. Box 6474
Indianapolis, IN 46206-6474

Contact Enrollment:

855-834-5596

Hours Available:

Monday–Friday
8:00 a.m.–4:00 p.m. CT
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

Form(s) you'll need:

CMS-855A - Medicare Enrollment Application form for Institutional Providers
CMS-588 - Electronic Funds Transfer (EFT) Authorization Agreement form

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 46206-7149

Contact Enrollment:

855-593-8047

Hours Available:

Monday–Friday
8:00 a.m.–4:00 p.m. ET

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

Form(s) you'll need:

CMS-855A - Medicare Enrollment Application form for Institutional Providers
CMS-588 - Electronic Funds Transfer (EFT) Authorization Agreement form