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October 25, 2021

Who to Contact Regarding Your Applications!

Share this information with your staff!

To ensure providers and suppliers are contacting the correct Customer Service line for questions about an EDI or Provider Enrollment application, please see the chart below:

Part A – 866.590.6703
Part B – 866.276.9558
HH&H – 877.299.4500

Who to Contact

Electronic Data Interchange (EDI) Applications Provider Enrollment (PE) Applications

Part A, Part B, and HH&H

  • Administrative Simplification Compliance Act (ASCA) Request Form
  • Annual DDE PPTN Recertification Form
  • EDI Enrollment Agreement Form
  • EDI Enrollment Package
  • EDI Network Service Agreement
  • EDI Testing Application
  • J15 DDE PPTN Application/Reactivation
  • Online EDI Application

Select Option 2 for an EDI Customer Service Representative.

Part A and HH&H

  • CMS-855A
  • CMS-588
  • Electronic Funds Transfer
  • Exhibit 177 (Part A Only)
  • Authorized and Delegated Officials

Part B

  • CMS-20134
  • CMS 855B
  • CMS-855I
  • CMS-855O
  • CMS-855R
  • CMS 588
  • Electronic Funds Transfer
  • Opt-Out Affidavit Form
  • Participating Providers Agreement CMS-460
  • Authorized and Delegated Officials

Select Option 3 for an PE Customer Service Representative.


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