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J15 DDE PPTN: Application/Reactivation Form

On February 27, 2024, CGS deployed an online version of the J15 DDE PPTN: Application/Reactivation Form

The online form:

•       Allows users a more accurate and efficient process to obtain a User ID for DDE/ PPTN access

•       Eliminates errors encountered with the hardcopy form

•       Includes an electronic rather than a handwritten signature field A request ID is generated when you submit the application.

If the user(s) is located outside of the United States, please send a copy of the network connectivity diagram to CGS.EDI@CGSadmin.com, and include your request ID in the subject line of the email. Note: CGS will reject paper forms received after March 27, 2024.

Click here to view the form on the CGS Medicare website.