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May 28, 2019

New Revised J15 DDE PPTN Application/Reactivation Form

CGS is introducing a new and improved form for DDE and PPTN access. The major change with the J15 DDE PPTN Application/ReactivationPDF form is the EDI Contact requesting access for users must identify if the user(s) are Outside of the United States. For users Outside the United States, a diagram of their network connectivity must be submitted with the application. The signature of the EDI Contact is now a required field. Applications received after August 1, 2019 must have a signature and answer the question "Is the User located outside the United States?"

This form is available for use immediately. Beginning August 1, 2019, 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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