New Revised J15 DDE PPTN Application/Reactivation Application
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January 24, 2018Updated 02.24.20

New Revised J15 DDE PPTN Application/Reactivation Application

CGS is introducing a new and improved form for DDE and PPTN access. The Online Inquiry form is now called the J15 DDE PPTN Application/ReactivationPDF. The name change was made for the provider community to help them better locate the form on our website. The major change with the DDE PPTN access request is CGS will no longer accept attached spreadsheets. Only 5 PTAN/NPI combinations can be submitted per application. This change is to ensure the requests are processed correctly and timely.

This form is available for use immediately. As of March 1, 2018, forms received with an attached spreadsheet or the old form will be returned to the provider.

Note: Only 2 applications per fax transmission are allowed.

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