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DDE Submitter ID Request

Use this form to request a DDE Submitter ID or make changes to an existing Submitter ID. Restricted authorization permits only authorized signers in a provider office. Regulation does not allow Third Party Billers and Medicare Billers to apply for a DDE Submitter ID.

WPS GHA PART A
For instructions on how to use this form, please follow this link.

  1. If this is a request for a "Need DDE Submitter ID", your Facility Administrator will need to state, on company letterhead, that they are giving you authorization to obtain a Submitter ID. In the case where the Facility Administrator is requesting a “Need DDE Submitter ID”, then another authorized signer from the facility will need to complete the letter. The Facility Administrator (or other facility authorized signer) must sign, date and scan the letter.
  2. Email the required letter from the email address you listed on this form or if the Administrator emails they need to include your name in the subject line. Email the form to Medicare.DDE.Analysts@wpsic.com.
  3. You will receive an email with your new DDE Submitter ID.

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