Physicians, non-physician practitioners, physician organizations, non-physician organizations, and Medicare Diabetes Prevention Program suppliers don’t pay a Medicare enrollment application fee.
Generally, institutional providers and suppliers like DMEPOS suppliers and opioid treatment programs pay an application fee when enrolling, re-enrolling, revalidating, or adding a new practice location.
Whether you apply for Medicare enrollment online or use the paper application, you can pay the Medicare application fee online through:
A hardship exception exempts you from paying a current application’s fee. If you request a hardship exception, submit a written request and supporting documentation describing the hardship and justifying an exception to paying the application fee with your PECOS or CMS paper application. We grant exceptions on a case-by-case basis.
Medicare Administrative Contractors (MACs) will only process applications with the proper application fee payment or an approved hardship exception.
If you don’t pay the fee or submit a hardship exception request, your MAC will send a letter allowing you 30 days to pay the fee. If you don’t pay the fee on time, the MAC may reject or deny your application or revoke your existing billing privileges, as appropriate.
Providers must enroll in the Medicare Program to get paid for providing covered services to Medicare patients. Determine if you’re eligible to enroll and how to complete enrollment.
Who Are Institutional Providers? ⤵
Physicians, non-physician practitioners (NPPs), clinics or group practices, and specific suppliers who can enroll as Medicare Part B providers are defined in enrollment forms Medicare Enrollment Application: Physicians and Non-Physician Practitioners (CMS-855I) and Medicare Enrollment Application: Clinics/Group Practices and Other Suppliers (CMS-855B).
NPPs include nurse practitioners, clinical nurse specialists, and physician assistants who practice with or under a physician’s supervision.
Beginning January 1, 2024, we established new provider specialty codes for dentists.
If you don’t see your provider type listed, contact your MAC’s provider enrollment center before submitting a Medicare enrollment application.
Provider & Supplier Organizations ⤵Medicare provider and supplier organizations have business structures, like corporations, partnerships, professional associations, or limited liability companies, which meet the provider and supplier definitions. Provider and supplier organizations don’t include organizations the IRS defines as sole proprietorships.
Provider and supplier organizations include:
You must have a provider or supplier employer identification number (EIN) to enroll in Medicare. An EIN is the same as the provider or supplier organization’s IRS-issued tax identification number (TIN).
Sections 10.6.4 and 10.6.7.1(D)(5) of Medicare Program Integrity Manual, Chapter 10 have more information about sole proprietorships and disregarded entities.
Decide If You Want to Be a Medicare Part B Participating Provider ⤵Medicare participation means you agree to accept claims assignment for all covered patient services. By accepting assignment, you agree to accept Medicare-allowed amounts as payment in full. You can’t collect more from the patient than the deductible and coinsurance or copayment. The Social Security Act says you must submit patient Medicare claims whether or not you participate.
You have 90 days after we send your initial enrollment approval letter to decide if you want to be a participating provider or supplier. To participate as a Medicare Program provider or supplier, submit the Medicare Participating Physician or Supplier Agreement (CMS-460) upon initial enrollment. The only other time you may change your participation status is during the open enrollment period, generally from mid-November–December 31 each year.
To enroll in the Medicare Program, get an NPI through:
Search for your NPI on the NPPES NPI Registry.
To better protect your information, we implemented I&A System multi-factor authentication for the provider enrollment systems listed above.
After you get an NPI, you can complete Medicare Program enrollment, revalidate your enrollment, or change your enrollment information. Before applying, get the necessary enrollment information, and complete the actions using PECOS or the paper enrollment form.
After we approve your I&A System registration, submit your PECOS application.
PECOS offers a scenario-driven application, asking questions to recover the information for your specific enrollment scenario. You can use PECOS to submit all supporting documentation. Follow these instructions:
PECOS will have enhanced features to better meet your needs. Watch this 2-minute video or read these FAQs to learn more about:
Visit Introducing PECOS 2.0 for more information.
PECOS validates that you’ve read and acknowledged certification terms and conditions before you electronically submit your Medicare enrollment application. Review and scroll through each text box with certification requirements before you can select accept on these pages:
Enrolling physicians, NPPs, or other Part B suppliers must choose 1 of the application descriptions below.
Submit the appropriate paper enrollment application if you’re unable to use PECOS. Carefully review the paper application instructions to decide which form is right for your practice. The paper enrollment application collects your information, including documentation verifying your Medicare Program enrollment eligibility.
If you submit a paper application, your MAC processes your application and creates a Medicare enrollment record by entering the data into PECOS.
Medicare Enrollment Application: Institutional Providers (CMS-855A): Institutional providers use this form to begin the Medicare enrollment or revalidation process or to change enrollment information.
Physicians, NPPs, & Other Part B Suppliers, Including Opioid Treatment Programs ⤵Most physicians and NPPs complete the CMS-855I to begin the enrollment process. You can also use the CMS-855I if you reassign your benefits to another entity, like a medical group or group practice that gets paid for your services. We’ve merged the CMS-855R into the CMS-855I paper enrollment application.
Certified Providers & State Survey Agency ⤵After you submit an enrollment application and all required supporting documentation to your MAC, they’ll send their recommendations to the State Survey Agency. The State Survey Agency then decides if specific providers meet Medicare enrollment conditions.
After a MAC makes a recommendation, the State Survey Agency or a CMS-recognized accrediting organization conducts a survey. Based on the survey results, the agency or organization recommends that we approve or deny the enrollment (certification of compliance or non-compliance).
Certain institutional provider types may elect voluntary accreditation by a CMS-recognized accrediting organization instead of a State Survey Agency. The accrediting organization will notify the State Survey Agency of their decision.
The State Survey Agency forwards us the survey results. We assign the CMS Certification Number and effective date, sign the provider agreement, and update the certification database. Your MAC will issue your final approval or denial letter.
If approved, you’ll get a fully executed provider agreement.
If enrolling in Medicare, revalidating, or making certain changes to your enrollment, we require you to set up an electronic funds transfer (EFT). Enroll in EFT by completing the PECOS EFT information section. When submitting a PECOS application:
MACs pre-screen and verify enrollment applications for completeness. If the MAC needs more information, respond to information requests within 30 days. If you don’t, the MAC may reject your enrollment.
Your MAC won’t fully process your PECOS enrollment application without your electronic or uploaded signature, application fee (if applicable), and necessary supporting documentation. The enrollment application filing date is when the MAC gets your enrollment application.
You can check your PECOS enrollment application status 2 ways:
When your MAC approves your application, it switches the PECOS record to an approved status and sends you an approval letter.
We conduct a site visit verification process using National Site Visit Contractors (NSVCs). A site visit helps prevent questionable providers and suppliers from enrolling or staying enrolled in the Medicare Program.
The NSVCs conduct unannounced site visits for all Medicare Part A and B providers and suppliers, including DMEPOS suppliers. The NSVCs may conduct an observational site visit or a detailed review to verify enrollment-related information and collect other details based on pre-defined CMS checklists and procedures.
During an observational visit, the inspector has minimal contact with the provider or supplier and doesn’t hinder the facility’s daily activities. The inspector will take facility photos as part of the site visit. During a detailed review, the inspector enters the facility, speaks with staff, and collects information to confirm the provider’s or supplier’s compliance with our standards.
Inspectors performing site visits will carry a photo ID and a CMS-issued, signed authorization letter the provider or supplier may review. If the provider or its staff want to verify we ordered a site visit, contact your MAC.
Make your office staff aware of the site visit verification process. An inspector’s inability to perform a site visit may result in denial of your Medicare enrollment application or revocation of your Medicare billing privileges.
Report a Medicare enrollment change using PECOS. Physicians, NPPs, and physician and NPP organizations must report a change of ownership or control (including a change in authorized or delegated official), a change in practice location, and any final adverse legal actions (like a felony or suspension of a federal or state license) within 30 days of the change and report all other changes within 90 days of the change.
DMEPOS suppliers must report changes in their enrollment application information within 30 days of the change.
Independent diagnostic testing facilities must report changes in ownership, location, general supervision, and adverse legal actions within 30 days of the change and report all other changes within 90 days of the change.
Medicare Diabetes Prevention Program suppliers must report changes in ownership, including AO or Access Manager; location; coach roster; and adverse legal actions within 30 days of the change and report all other changes within 90 days of the change.
We allow various organizations and users to work in our systems. The type of user depends on their relationship with you and the duties they perform in your practice.
You may choose other users to act for your organization to manage connections and staff, including appointing and approving other system-authorized users. Depending on your professional relationships with other providers, the CMS External User Services Help Desk may ask you for additional validation information.
We use several provider enrollment systems. Organizational providers and suppliers must use the Identity & Access Management (I&A) System to name an AO to work in CMS systems. The I&A System allows you to:
Organizational providers or suppliers must appoint and authenticate an Authorized Official (AO) through the I&A System to work in PECOS for them. That person must meet the AO regulatory definition. For example, an AO is a chief executive officer, chief financial officer, general partner, chair of the board, or direct owner who can legally enroll in the Medicare Program.
Respond to your employer’s AO invitation or initiate the request yourself. After you’re the confirmed AO, use PECOS for your provider or supplier organization. As an AO, you’re responsible for approving PECOS user system requests to work on behalf of the provider or supplier organization. Regularly check your email and take the requested actions.
AOs may delegate their responsibilities to an Access Manager who can also initiate or accept connections and manage staff for their organizations.
AOs or Access Managers may invite a Staff End User (SEU) or Surrogate to access PECOS for their organization. Once registered, an SEU or Surrogate may log in to access, view, and modify CMS system information, but they can’t represent the practice, manage staff, sign enrollment applications, or initiate or accept connections.
| Role | Represent an Organization | Manage Staff | Approve or Manage Connections | Act on Behalf of Provider in CMS Systems |
|---|---|---|---|---|
| Individual Provider | Yes | Yes | Yes | Yes |
| AO | Yes | Yes | Yes | Yes |
| Access Manager | Yes | Yes | Yes | Yes |
| SEU | No | No | No | Yes |
| Surrogate | No | No | No | Yes |
We recommend using the same I&A System-appointed AO and PECOS Access Managers. The assigned AO and Access Managers must have the right to legally bind the company and be responsible for approving the system staff and be CMS-approved in the I&A System.
Only AOs can sign an initial organization enrollment application. An Access Manager can sign changes, updates, and revalidations.
The I&A System Quick Reference Guide has detailed instructions on managing system users.
Using PECOS may require technical support. The first step toward a solution is knowing which CMS contractor to contact.
You experience system-generated error messages, have trouble navigating through or accessing PECOS screens, encounter printing problems, or your valid I&A System user ID and password won’t allow PECOS access because of a malfunction (for example, the website operates slowly or not at all or a system-generated error message prevents you from entering data).
A system-generated error message doesn’t include messages created when you enter data incorrectly or ignore system prompts.
Solution: Contact the CMS External User Services Help Desk
The External User Services website has information on common problems and allows you to ask questions, chat live with a support team member, or look up previous support history.
Phone: 1-866-484-8049 (TTY 1-866-523-4759)
EUS Hours of Operation:
Before you log in to PECOS, you need a valid I&A System user ID and password.
Passwords expire every 60 days. The I&A System tells you the number of days until your password expires. If you attempt to log in to PECOS with an expired password, the system redirects you to the I&A System to reset it.
Solution: Access I&A System or Contact I&A System Help
The I&A System website lets you create an I&A System user ID and password, change your password, and recover forgotten login information. You can also access several resources:
On the I&A System website, select the Help button in the upper right corner of any webpage for more information on that webpage’s topic.
Problem: Enrolling in Medicare via PECOS (Non-Technical) ⤵While using PECOS, you may have questions, experience problems enrolling, or need help completing specific PECOS enrollment application sections.
Solution: Contact Your Medicare Enrollment Contractor
Find detailed enrollment contact information in the Medicare Provider Enrollment Contact List. If you have questions, find your MAC’s website.
Problem: Not Sure Who to Call for a Particular Issue ⤵Solution: Refer to the CMS Provider Enrollment Assistance Guide
Find detailed enrollment contact information in the Medicare Provider Enrollment Contact List.
Organizational providers and suppliers must designate a provider enrollment AO to work in CMS systems, including the I&A System, NPPES, and PECOS. The AO may also authorize Access Managers, Surrogates, and SEUs to use PECOS. Individual providers and suppliers don’t require an AO but can authorize Surrogates and SEUs to work in PECOS. Refer to the I&A System Quick Reference Guide and I&A FAQs for more information on registering for an I&A System account or enrolling as an AO.
What login information do I need before accessing PECOS? ⤵We use several provider enrollment systems. Specifically, the I&A System allows you to:
Before completing PECOS enrollment, create an I&A System account. Organizational providers and suppliers must designate an AO to work in these systems.
What information do I need before I begin my enrollment in PECOS? ⤵Use the same information to enroll in Medicare using PECOS as you would for a paper enrollment application.
Search for your NPI on the NPPES NPI Registry.
Based on your provider type, you may also need this information:
An application is the paper or electronic form you submit for Medicare Program enrollment approval. After the MAC processes the application, PECOS keeps the enrollment record, which includes all your enrollment application data.
What enrollment changes can’t you make through PECOS? ⤵You can’t use PECOS to:
Submit changes noted above using the appropriate paper Medicare enrollment application.
Are any provider or supplier types restricted from using PECOS? ⤵No. All Fee-for-Service (FFS) providers can apply in PECOS.
When’s PECOS available? ⤵PECOS is available 24 hours a day, Monday–Saturday, with scheduled downtime on Sunday. We offer technical support daily, 5 am–8 pm CT.
Am I required to complete and submit enrollment applications in PECOS? ⤵We encourage you to submit your enrollment application through PECOS because it’s faster and easier, but you may complete and mail the appropriate paper Medicare enrollment application to the address on the Medicare Fee-for-Service Provider Enrollment Contact List:
Even if you submit your application on a paper form, your MAC creates an enrollment record in PECOS.
How will I know if I successfully submitted my electronic PECOS enrollment application? ⤵When you electronically submit your Medicare enrollment application, you’ll get a Submission Confirmation page, which will remind you that the individual provider, or the provider or supplier organization AO or Access Manager must electronically sign the application or upload their signature. You’ll be able to see which MAC is processing your application, your unique application tracking number, and real-time information about your application.
PECOS emails the web tracking ID for the submitted application to each address in the Contact Person section of the application. Remember to verify all your completed signatures with either an electronic signature or uploading certification. Mail any required supporting documentation you didn’t upload during submission to the MAC, and include the PECOS tracking ID.
How do I know when I need to create a new enrollment? ⤵Create a new enrollment:
Generally, institutional providers and suppliers, like DMEPOS suppliers and opioid treatment programs, pay an application fee when enrolling, re-enrolling, revalidating, or adding a new practice location.
What’s the hardship exception to the application fee? ⤵A hardship exception exempts you from paying a current application’s fee. If you request a hardship exception, submit a written request and supporting documentation describing the hardship and justifying an exception to paying the application fee with your PECOS or CMS paper application. We grant exceptions on a case-by-case basis.
MACs will only process applications with the proper application fee payment or an approved hardship exception.
What happens if I don’t submit the fee or hardship exception request? ⤵If you don’t pay the fee or submit a hardship exception request, your MAC will send a letter allowing you 30 days to pay the fee. If you don’t pay the fee on time, the MAC may reject or deny your application or revoke your existing billing privileges, as appropriate.
If you pay the fee during the 30-day period, the MAC processes the application in the usual manner.
Do I need to submit additional information outside PECOS to complete the application? ⤵No. When you electronically submit the Medicare enrollment application, a page appears that lists the supporting documentation to complete the enrollment. You can submit all this documentation electronically through PECOS.
Do I need to confirm my account information using bank letterhead or a voided check if I electronically submit and sign the Electronic Funds Transfer (EFT) Agreement (CMS-588)? ⤵
Yes, either is acceptable. You must send this information electronically (as supporting documentation uploaded into PECOS).
What are the penalties for falsifying information when using PECOS? ⤵During the PECOS application process, the Penalties for Falsifying Information page has the same text as the paper Medicare enrollment application and lists the consequences for providing false information. These consequences include criminal and civil penalties, fines, civil monetary penalties, exclusion from federal health care programs, and imprisonment, among others. You must acknowledge this page by selecting the Next Page button before continuing the PECOS submission process.
First, make sure you entered your correct SSN, legal name, and date of birth. If you believe you entered the correct information but PECOS doesn’t accept this information, contact the Social Security Administration.
I’m a physician or NPP. What should I do if I don’t have an SSN or don’t want to use my SSN in a web transaction? ⤵
You must report an SSN to enroll in Medicare. If you don’t want to report your SSN over the web, use the appropriate paper Medicare enrollment application.
I see an Invalid Address error. How do I resolve this? ⤵An Invalid Address error indicates the address entered doesn’t comply with the U.S. Postal Service address standards. This page lets you continue by either saving the address you entered or selecting the address PECOS displays.
When using PECOS, will the system time me out? ⤵As a security feature, PECOS will time out if you’re inactive (you don’t hit any keys on your computer keyboard) for 15 minutes. The system warns you of inactivity after 10 minutes. If it gets no response after 5 additional minutes, the system automatically times you out. Save your work if you anticipate inactivity while applying in PECOS. If you don’t save your work and the system times out, you must start from the beginning.
No. If you report a change to existing information, check Change, include the effective date of change, and complete the appropriate fields in the impacted sections.
My information changed. Do I have to update my Medicare enrollment information? ⤵Yes. Following your initial enrollment, report certain changes (reportable events) to your MAC within 30 calendar days of the change. Report all other changes to your MAC within 90 days.
What’s a reportable event? ⤵Report a Medicare enrollment change using PECOS. Physicians and NPPs must report a change of ownership or control (including a change in authorized or delegated official), a change in practice location, and any final adverse legal actions (like a felony or suspension of a federal or state license) within 30 days of the change and report all other changes within 90 days of the change.
DMEPOS suppliers must report changes in their enrollment application information within 30 days of the change.
Independent diagnostic testing facilities must report changes in ownership, location, general supervision, and adverse legal actions within 30 days of the change and report all other changes within 90 days of the change.
Medicare Diabetes Prevention Program suppliers must report changes in ownership, including AO or Access Manager; location; coach roster; and adverse legal actions within 30 days of the change and report all other changes within 90 days of the change.
What’s the Special Payments address? ⤵Since Medicare pays claims by EFT, the Special Payments address should indicate where all other payment information must go (for example, paper remittance notices or special payments).
How do I change provider enrollment information? ⤵Providers and suppliers should report most changes using PECOS or the applicable paper Medicare enrollment application.
I’m a DMEPOS supplier, and I have a new business location. Can I add this location to an existing PECOS enrollment? ⤵
No. If you have a new business location, complete a new PECOS or paper application. Each DMEPOS enrollment record can only have 1 current business location.
Revalidation means resubmitting and recertifying your enrollment information.
My MAC requested I revalidate my enrollment information. What does this mean? Can I complete the action using PECOS? ⤵
DMEPOS suppliers must revalidate every 3 years, while all other providers and suppliers generally revalidate every 5 years. We can also conduct off-cycle revalidations. You can revalidate using PECOS or by submitting the appropriate paper Medicare enrollment application.
When do I revalidate? ⤵If you’re currently enrolled, check the Medicare Revalidation List to find your revalidation due date. If you see a due date, submit your revalidation before that date. Your MAC will also send you a revalidation notice.
Yes. Your MAC will send a revalidation notice 90–120 days before your revalidation due date.
Should I submit my revalidation if I don’t have a notice from my MAC? ⤵If there’s no due date listed on the Medicare Revalidation List or you didn’t get a MAC letter requesting revalidation, don’t submit your revalidation application. Your MAC will return it to you.
However, if you’re within 2 months of the due date listed on the Medicare Revalidation List and didn’t get a MAC notice to revalidate, submit your revalidation application.
Can I revalidate without completing the entire enrollment application again? ⤵Yes. PECOS lets you review information on file and update and electronically submit your revalidation. If you use PECOS, you need to update only changed information.
What will happen if I don’t submit my revalidation by the due date? ⤵If you submit your revalidation after its due date, your MAC may place a hold on your Medicare payments or deactivate your Medicare billing privileges. If the MAC requests additional documentation, respond within 30 days. If you don’t, they may deactivate your Medicare billing privileges.
If the information in my revalidation is different than what CMS has on file about my practice location, authorized representatives, or other pertinent information, will I get penalized for not reporting the change within the required time frames? ⤵
Revalidation ensures all provider enrollment records are accurate and current. Generally, we don’t take administrative action against a provider or supplier for updating their records even though it wasn’t timely. However, we could take administrative actions, including recovering previous Medicare payments, when a provider or supplier that fails to report the change causes their Medicare enrollment to become ineligible.
PECOS users can’t mail documents that require a signature. When submitting your application, be prepared to send an e-signature or upload your signed documents.
You can help protect your professional medical identifiers from identity thieves attempting to defraud the Medicare Program.
Log in to PECOS and review your Medicare enrollment information several times a year to ensure no unauthorized changes were made.
Only you, authorized surrogates, authorized CMS officials, and MACs may enter and view your Medicare PECOS enrollment information. CMS officials and MACs get security standards training and must protect your information. We don’t disclose your Medicare enrollment information to anyone, except when authorized or required by law.
Review your Medicare enrollment information in PECOS frequently to ensure it’s accurate, current, and unaltered.
Use your I&A System user ID and password to access PECOS. Keep your ID and password secure.
Your NPI and TIN are publicly available information. Use extra caution to monitor and protect your professional and personal information to help prevent fraud and abuse. Also ensure your patients’ personal health information is secure. Refer to these resources:
Take these steps to verify your Medicare enrollment information:
If you suspect your PECOS profile is incorrect due to unauthorized account access, contact your MAC, law enforcement authorities, and your bank. Your MAC and bank can flag your respective accounts for possible fraudulent activity, and law enforcement can begin investigating if and how your accounts were compromised.
Take these additional actions to protect your Medicare enrollment information:
To enroll or keep your Medicare billing privileges, all DMEPOS suppliers (except certain exempted professionals) must meet supplier and DMEPOS Quality Standards to become accredited. Certain DMEPOS suppliers must also submit a surety bond.
DMEPOS suppliers (except those exempted eligible professionals and other persons) must be accredited by a CMS-approved accrediting organization before submitting a Medicare enrollment application to the National Provider Enrollment (NPE) DMEPOS contractors.
Each enrolled DMEPOS supplier covered under the Health Insurance Portability and Accountability Act (HIPAA) must name each practice location (if it has more than 1) as a sub-part and make sure each sub-part gets its own NPI.
Physicians, NPPs, and DMEPOS suppliers may use their I&A System user ID and password to access PECOS. If you don’t already have an I&A System account, refer to the I&A System User Registration page and enter the information to open an account. For help, refer to the How to Setup Your Account if you are a Sole Owner section in the I&A System Quick Reference Guide.
As an individual DMEPOS supplier, you don’t need an AO or another authorized user.
A DMEPOS supplier organization must appoint an AO to manage connections and staff, including appointing and approving other authorized PECOS users. The organization must identify the AO in the enrollment application. The AO must have ownership or managing control in the DMEPOS supplier organization.
Physicians and other eligible professionals must enroll in the Medicare Program or have a valid opt-out affidavit on file to solely order or certify Medicare patient items or services.
Those physicians and other eligible professionals enrolled solely as ordering/certifying providers don’t send billed service claims to a MAC.
Part B claims use the term ordering/certifying provider to identify the professional who orders or certifies an item or service reported in a claim. These are technically correct terms:
The health care industry uses the terms ordered, referred, and certified interchangeably.
Physicians or eligible professionals who order or certify Part A or Part B services but don’t want to submit Medicare claims are eligible ordering/certifying providers.
A person already enrolled as a Part B provider may submit claims listing themselves as the ordering/certifying provider without re-enrolling using Medicare Enrollment Application: Enrollment for Eligible Ordering/Certifying Physicians and Other Eligible Professionals (CMS-855O).
Note: Those who enroll as eligible providers using CMS-855O can’t bill Medicare, and we can’t pay for their services because they have no Medicare billing privileges.
Organizational NPIs don’t qualify, and you can’t use them to order or certify.
Eligible providers must meet these basic conditions:
If claims lack a valid individual NPI, MACs deny them if they’re from:
If you bill a service that needs an eligible provider and they aren’t on the claim, the MAC will deny the claim. The claim must have a valid NPI and the eligible provider’s name as it appears in PECOS.
If a provider who’s on the Preclusion List prescribes a Medicare Part D drug, drug plans will deny it.
The 2 types of NPIs are: Type 1 (individual) and Type 2 (organizational). Medicare allows only Type 1 NPIs to solely order items or certify services. Apply for an NPI through:
Once you have an NPI, use PECOS to verify current Medicare enrollment record information, including your NPI and that you’re approved, or go to the Opt Out Affidavits list to check your status. To opt out of Medicare, submit an affidavit expressing your decision to opt out of the program.
Part C and Part D providers don’t have to enroll in Medicare in an approved or opt-out status.
| Verification Option | Enrollment Record Is Current If: |
|---|---|
| Go to the Order and Referring datasets.* | You’re on 1 of these reports. |
| Go to PECOS to find your enrollment record. | Your enrollment record displays an approved status. |
| If you submitted an enrollment application as 1 of the eligible provider types on paper (CMS-855O) or using PECOS and want to check the status, go to the Pending Initial Logging and Tracking Non Physicians and Pending Initial Logging and Tracking Physicians datasets. | Your enrollment application is pending contractor review if you’re on 1 of these reports. |
*We deny certain power mobility device claims if the ordering provider isn’t on our eligible providers list.
The physicians and eligible professionals who may enroll in Medicare solely for ordering or certifying include, but aren’t limited to, physicians and eligible professionals who are:
If you’re unsure whether your specific provider specialty qualifies to enroll as an ordering/certifying provider, refer to Section 4 of CMS-855O or find your MAC’s website before submitting a Medicare enrollment application.
Beginning January 1, 2024, we established new provider specialty codes for dentists.
Claims for items or services ordered or certified by licensed or unlicensed interns and residents must specify a teaching physician’s NPI and name. State-licensed residents may enroll to order or certify and can be listed on claims. If states offer provisional licenses or otherwise permit residents to order/certify, we allow interns and residents to enroll consistent with state law.
MACs pre-screen and verify enrollment applications for completeness. If the MAC needs more information, respond to information requests within 30 days. If you don’t, the MAC may reject your enrollment.
Your MAC won’t fully process your PECOS enrollment application without your electronic or uploaded signature, application fee (if applicable), and necessary supporting documentation. The enrollment application filing date is when the MAC gets your enrollment application.
You can check your PECOS enrollment application status 2 ways:
When your MAC approves your application, it switches the PECOS record to an approved status and sends you an approval letter.
Report a Medicare enrollment change using PECOS. Providers and suppliers must report a change of ownership or control (including a change in authorized or delegated official), a change in practice location, and any final adverse legal actions (like revocation or suspension of a federal or state license) within 30 days of the change and must report all other changes within 90 days of the change.
DMEPOS suppliers must report changes in their enrollment application information within 30 days of the change.
Independent diagnostic testing facilities must report changes in ownership, location, general supervision, and adverse legal actions within 30 days of the change and report all other changes within 90 days of the change.
Medicare Diabetes Prevention Program suppliers must report changes in ownership, including AO or Access Manager; location; coach roster; and adverse legal actions within 30 days of the change and report all other changes within 90 days of the change.
Revalidation, or re-submitting and recertifying your enrollment information accuracy, is an important anti-fraud tool. All Medicare-enrolled providers and suppliers must periodically revalidate their enrollment information.
Generally, physicians, including physician organizations, opioid treatment programs, Medicare Diabetes Prevention Program suppliers, and institutional providers, revalidate enrollment every 5 years or when we request it. DMEPOS suppliers must revalidate their enrollment information every 3 years.
PECOS is the most efficient way to revalidate information.
If you’re actively enrolled, go to the Medicare Revalidation List to find your revalidation due date. If you see a due date, submit your revalidation before that date. Your MAC notifies you when it’s time to revalidate. If you submit your revalidation application after the due date, your MAC may hold your Medicare payments or deactivate your billing privileges.
MACs issue Medicare billing privilege deactivations. We permit providers and suppliers to file a rebuttal.
Get more information:
Groups with more than 200 members can use the Medicare Revalidation List and search by their organization’s name to download group information. Their MAC will send them a letter and spreadsheet that lists the providers linked to their group who must revalidate within 6 months. Large groups should work together to ensure they submit only 1 application from each provider or supplier.
Use these resources to learn how to enroll in the Medicare Program, revalidate your enrollment, or change your enrollment information. Enroll in the Medicare Program to get paid for providing covered patient services. Enroll if you solely order items or certify services.
You can enroll online by using PECOS or the appropriate paper enrollment application you submit to your MAC.
If you enroll using a paper application instead of PECOS, search the CMS Forms List to find the form you need and read on page 1, Who Should Submit This Application.
| Form | Form Number |
|---|---|
| Electronic Funds Transfer (EFT) Authorization Agreement | CMS-588 |
| Health Insurance Benefit Agreement | CMS-1561 |
| Medicare Enrollment Application: Clinics/Group Practices and Other Suppliers | CMS-855B |
| Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers | CMS-855S |
| Medicare Enrollment Application: Enrollment for Eligible Ordering/Certifying Physicians and Other Eligible Professionals | CMS-855O |
| Medicare Enrollment Application: Institutional Providers | CMS-855A |
| Medicare Enrollment Application: Medicare Diabetes Prevention Program (MDPP) Suppliers | CMS-20134 |
| Medicare Enrollment Application: Physicians and Non-Physician Practitioners | CMS-855I |
| Medicare Participating Physician or Supplier Agreement | CMS-460 |
| National Provider Identifier (NPI) Application/Update Form | CMS-10114 |
CMS CMS is the federal agency that administers the Medicare, Medicaid, Children’s Health Insurance Program (CHIP), HIPAA, Clinical Laboratory Improvement Amendments (CLIA), and several other health-related programs. CMS-460 The Medicare Participating Physician or Supplier Agreement describes your willingness to accept assignment for all covered services you provide to patients. If you participate, we pay 5% more, and participating providers get timely, direct payment. CMS-588 The Electronic Funds Transfer (EFT) Authorization Agreement tells you how to get electronic payments or update existing banking information. CMS-855A The Medicare enrollment application institutional providers use to enroll, revalidate enrollment, or change enrollment information. CMS-855B The Medicare enrollment application clinics or group practices and other suppliers (except DMEPOS suppliers) use to enroll, revalidate enrollment, or change enrollment information. CMS-855I The Medicare enrollment application physicians and non-physician practitioners (NPPs) (individual physicians or NPPs) use to enroll, revalidate enrollment, or change enrollment information. Physicians and NPPs can also reassign their right to bill the Medicare Program, terminate a current reassignment of Medicare benefits, or make a change in their reassignment of Medicare benefit information using the CMS-855I. CMS-855O The Medicare enrollment application eligible ordering, certifying, and prescribing physicians and other eligible professionals (physicians, including dentists and other eligible NPPs) use to enroll to order items or certify patient services. This includes those physicians and other eligible NPPs who don’t and won’t send patient service claims to a MAC. CMS-855S The Medicare enrollment application DMEPOS suppliers use to enroll, revalidate enrollment, or change enrollment information. CMS-1561 The Health Insurance Benefit Agreement is an agreement between a provider and CMS to get Medicare payments. CMS-10114 This form tells you how to apply or submit NPI updates. CMS-20134 The Medicare enrollment application Medicare Diabetes Prevention Program suppliers use to enroll, revalidate enrollment, or change enrollment information. Director A director of a corporation, even when the provider or supplier is a non-profit entity. This includes any member of the corporation’s governing body regardless of the board’s or member’s specific title. The body could be a board of directors, board of trustees, or something similar. DMEPOS Suppliers Entities or persons, including physicians or Part A providers, who sell or rent Medicare Part B covered items to patients and meet the DMEPOS supplier standards. Electronic File Interchange (EFI) The EFI process lets CMS-approved EFI Organizations electronically submit provider NPI applications and update NPPES information with minimal manual intervention. Electronic Funds Transfer (EFT) We directly pay EFT providers by sending payments to the provider’s financial institution whether they file claims electronically or on paper. All our providers must apply for EFT. Electronic Health Record (EHR) An EHR is an electronic version of a patient’s medical history. External User Services (EUS) Help Desk EUS is a dedicated CMS online support site offering help, including, but not limited to, the Identity & Access Management (I&A) System, PECOS, and NPPES. Identity & Access Management (I&A) System Users register for usernames and passwords to access PECOS, NPPES, and the EHR Incentive Program. Institutional Provider These are providers or suppliers that submit a CMS-855A, CMS-855B (except physician and NPP organizations), or CMS-855S form. See page 1 of the respective provider-type forms about who should use them. Managing Organization An entity that exercises operational or managerial control over, or directly or indirectly conducts, the day-to-day operations of the provider or supplier, either under contract or through some other arrangement. Medicare Administrative Contractor (MAC) A private company that contracts with us to process and pay Fee-for-Service patient Part A and Part B medical or DME claims. Medicare Application Fee Institutional providers and suppliers must pay an application fee when they initially enroll in Medicare, add a practice location, or revalidate their enrollment information. We define an institutional provider as any provider or supplier that submits a CMS-855A, CMS-855B (except physician and NPP organizations), or CMS-855S form. NPPES NPPES assigns unique NPIs to Medicare providers and health plans to improve the efficiency and effectiveness of electronically submitting health information. National Site Visit Contractor (NSVC) The NSVC performs a site visit to screen and stop questionable providers and suppliers from enrolling or maintaining enrollment. NPI Enumerator The NPI Enumerator helps Medicare providers apply for NPIs and update their information in NPPES. NPI Registry The NPI Registry is a directory of all active NPI records that displays relevant public portions of the record, including the provider’s name, specialty, and practice address. Officer An officer of a corporation, regardless of whether the provider or supplier is a non-profit entity. Participating Physician or Supplier Participating physicians or suppliers agree to accept patient assignment on Medicare service claims. They agree to accept allowed amounts as payment in full and to collect only the deductible and coinsurance or copayment. See CMS-460. PECOS PECOS is CMS’s online provider enrollment system allowing registered users to securely and electronically submit and manage enrollment information. You can use PECOS instead of paper enrollment forms. Reassignment of Medicare Benefits Reassigning your Medicare benefits lets an eligible organization or group submit claims and get payment for Part B services you provide as a member of an organization or group. See CMS-855I. Revalidation A provider and supplier mandatory resubmission and recertification process to maintain enrollment information accuracy and Medicare billing privileges. The process ensures enrollment information on file remains complete and current and helps fight health care fraud. State Survey Agency They perform initial surveys and periodic resurveys of all institutional providers (including labs) and certain kinds of suppliers. These surveys determine if a provider or supplier meets the conditions to participate in the Medicare Program and evaluates their performance and quality of care.
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MLN9658742 January 2024
