NSC Web Form Submission

The NSC Web Form Submission Tool makes it quick and easy to submit enrollment information without requiring the submission of the CMS-855S Form. You can submit such documents as: Appeals, Certificates of Insurance, Rebuttals Due to Deactivation, Licenses, NPI Letters, Responses to SACU Requests, Surety Bonds and PAR Agreements. Such documents can be uploaded securely on our website.

You can only submit documentation if you have a DMEPOS supplier number/PTAN (active, deactivated or revoked). If you do not have a PTAN, you will need to submit your documentation via Provider Enrollment, Chain and Ownership System (PECOS) or hardcopy submission to the NSC for review. 

Please note, any CMS-885S Forms such as changes of information submitted with the tool will NOT be processed. 

NSCWebFormupdate.pdf (PDF - 123 KB)
Last Updated: 07/22/2022