How do I deactivate a Provider Secured Services ID?

To deactivate a Provider Secured Services ID that is no longer being used, list the following on your company letterhead (fax coversheet is not acceptable):

  • Office name
  • Office address
  • The user ID
  • Users name
  • Contact person name and e-mail address
  • A short note explaining that you would like the ID deactivated
  • Signature and title from a manager, provider or authorized individual with legal signing authority.

Fax the information to 1-800-495-0812.

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