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.