The following DMEPOS enrollment information may be submitted:
Certificates of Insurance, Licenses, NPI Letter, Responses to SACU Requests, Surety Bonds, PAR Agreements, Appeals and Rebuttals.
To upload the documentation to the NPE West, select the appropriate document type
from the dropdown box below and enter the required identifying information in the fields provided.
The documentation must be in PDF format. Ensure you include a copy of your current Liability Insurance Certificate,
listing the NPE West as the Certificate Holder.
IMPORTANT Note for Appeals and Rebuttals: The National Supplier Clearinghouse (NSC) will continue to process all appeals and rebuttals for DMEPOS
suppliers located in both the East and West regions. Novitas does not currently process appeals or rebuttals.
If located in a state east of the Mississippi River, the appeal or rebuttal must be submitted via paper and not via this web tool.
Please send appeals to
and rebuttals to NSC.Rebuttals@palmettogba.com or to either address below.
National Supplier Clearinghouse forspacingOvernight Mailing Address
Palmetto GBA, AG -495 forspacingforspaciNational Supplier Clearinghouse
PO Box 100142 forspacingforspacingfors Palmetto GBA
Columbia, SC 29202-3142 forspacinggfoAG-495
forspacingforspacingforspacingforspacin2300 Springdale Dr, Bldg 1
forspacingforspacingforspacingforspacinCamden, SC 29020
Do not submit a CMS-855S application or any changes of information with this Web form.
Any changes of information submitted with this form will be processed. Refer to our
Change of Information Guide
on how to submit any other enrollment information that needs to be updated.
To become a participating supplier, please submit a completed Form CMS-460.To change your status to non-participating, submit a request on your company's letterhead signed by the company's authorized or delegated official as previously reported to the NPE West.
You can only submit documentation if you have a DMEPOS 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 NPE West for review.