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Enroll/Make Changes via PECOS Web

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Enroll in Medicare

Welcome.

Prepare and Get Started

Before jumping into Medicare Enrollment applications, it is best to be prepared. To ensure a provider has everything necessary to properly complete the applicable application(s), check out the below table. Not all topics may apply to each applicant.

* Required for all applicants

Topic Brief Details
* Is Provider Eligible to Enroll in Medicare?
  • View a list of eligible Part B specialties on the Eligible Specialties webpage.
  • If a provider is unsure of which taxonomy code to choose, he/she should visit the Washington Publishing Company (WPC) website to view the Health Care Provider Taxonomy Code Set This link takes you to an external website.. Health Care Provider Taxonomy Codes define a health care service provider type, classification, and area of specialization.
* If Eligible, Group Member, Organization, Reassiging benefits, Sole Owner, or a Sole Proprietor?

To further help explain the differences, watch our How Do I Determine What I Am? This link will take you to an external website. Tutorial.

Group Member

  • Individuals who reassign all benefits to an organization or another individual
  • Individuals who have an arrangement with an employer to send in Medicare claims and get paid for your services rendered

Organization

  • Organizations have two or more owners
  • When enrolling, organizations will submit CMS-855B and CMS-588 EFT application when submitting via paper
  • If selecting to be participating, submit CMS-460. More information available on Participation webpage
  • Organizations obtain at least one organizational (Type 2) NPI
  • Organizations bill with a Tax ID

Reassigning Benefits

  • Right to bill Medicare program and receive Medicare payments for services you render are appointed to organization
  • In order to reassign benefits, both organization and provider must be enrolled in Medicare

Sole Owner

  • Owners of a Professional Corporation (PC), Professional Association (PA), or sometimes a Limited Liability Company (LLC)
  • Must obtain both an individual (Type 1) and organizational (type 2) NPI
  • Bills Medicare through corporate business entity. They bill Medicare by using an incorporated EIN
  • Has personal assets that are legally separate from business
  • Chooses Sole Owner of a PA, PC or LLC option when submitting online via Internet-based PECOS
  • Submits only CMS-855I, and CMS-588 EFT applications via paper to set up themselves and their organization
  • If selecting to be participating, submit CMS-460. More information available on Participation webpage

Sole Proprietor

  • Renders services in a facility that they own, lease or rent
  • Must obtain only an individual (Type 1) NPI
  • Is legally one and same with business and is personally responsible for any of business's financial obligations
  • Reports business's income and losses on a personal tax return
  • Has option of billing with their social security number or a non-incorporated Tax ID
  • Chooses Self-Employed/Sole Proprietor option when submitting online via Internet-based PECOS
  • Submits CMS-855I and CMS-588 EFT applications when submitting via paper
  • If selecting to be participating, submit CMS-460. More information available on Participation webpage
* If Eligible, Provider Must Obtain NPI via NPPES

Organizations, Suppliers, Physicians, or non-Physician Practitioners who want to bill Medicare must obtain a National Provider Identifier (NPI) via National Plan and Provider Enumeration System (NPPES). NPIs are used in administrative and financial transactions.

NPPES This link will take you to an external website. - Individuals and organizations use NPPES to apply for NPIs and to keep their NPI information up-to-date, including addresses, phone numbers, and taxonomy codes

NPI: What You Need to Know This link will take you to an external website. - Learn more about sole proprietors and difference between Type 1 and Type 2 NPIs

Individual providers must obtain a Type 1 (Individual) NPI, and organizations must obtain at least one Type 2 (Organization) NPI. The number of type 2 NPIs an organization obtains is an individual business decision.

  • Type 1 NPI - Physicians and non-physician practitioners
  • Type 2 NPIs - Physician groups, hospitals, nursing homes, group practices, pharmacies (not all inclusive listing)

When there are changes in information such as name, tax identification number (TIN), address, primary practice location, taxonomy code, contact person and/or authorized officials, providers must update their NPPES information and their Medicare enrollment within 30 days

View the National Provider Identifier (NPI) webpage for more details.

Is Provider Enrolling to Bill CAH Method II? If providing Part B services in a Critical Access Hospital (CAH), a provider must be reassigned to the CAH Provider Transaction Access Number (PTAN) and NPI(s). Watch our Enrollment on Demand Application Tutorials for proper application instructions.
Is Provider Enrolling to Order, Certify and/or Prescribe Only? If a provider does not want to bill Medicare but is looking to enroll for the sole purpose of ordering, certifying, and/or prescribing Part D drugs, view the Ordering, Certifying, and Prescribing webpage.
Sign Up for the Identity & Access Management System (I&A)

Applicable to providers using PECOS Web to apply or make changes (PECOS Web This link will take you to an external website. allows providers to securely submit applications and review/update current file information via the Internet)

I&A is the gateway to PECOS and manages who has access to change those enrollments. Everyone using PECOS must use their own User ID and Password. This User ID and Password combination is managed by the I&A. Use provider NPPES login for the I&A.

To learn more about IA&, PECOS and to access PECOS Web Required Information Checklists, visit our PECOS webpage.

Participate or Not Participate?

Applicable to Organizations, Sole Owners and Sole Proprietors only

To participate or not participate is a personal choice. To make an educated decision, a physician or supplier should carefully read and analyze the advantages and disadvantages of participation. He/she should also carefully evaluate the provider pricing fee schedule, and other fee schedules that may apply, to determine the impact this decision will have on the reimbursement amount.

To participate in the Medicare program means that the provider/organization agrees to accept assignment for all services furnished to Medicare beneficiaries. Becoming a Participant means you agree to accept the amount approved by Medicare as total payment for covered services. More information available on Participation webpage

A nonparticipating provider is a provider involved in the Medicare program who has enrolled to be a Medicare provider but chooses to receive payment in a different method and amount than Medicare providers classified as participating. The nonparticipating provider may receive reimbursement for rendered services directly from their Medicare patients. They submit a bill to Medicare so the beneficiary may be reimbursed for the portion of the charges for which Medicare is responsible. More information available on Nonparticipation webpage

* Have Supporting Documents Available Examples
  • Copies of licenses and/or certifications
  • Copy of provider IRS document containing full legal business name and Tax ID number (IRS Letter 147C, CP 575)
  • Voided check or bank letter for Organizations, Sole Owners and Sole Proprietors only

 

Required Applications and Tips

Providers may submit applications in one of two ways.

  1. Internet-based PECOS (highly encouraged method) - PECOS Web This link will take you to an external website. allows providers to securely submit applications and review/update current file information via the Internet. Prior to submission, providers must upload all required supporting documentation and electronically sign the certification statement
  2. Paper - Access all forms, view tutorials and read application instructions from the Noridian Forms webpage
Provider Type Required Application(s) Tips
Group Member
  • Approved providers reassigning benefits: CMS-855R
  • New providers reassigning benefits: CMS-855I, CMS-855R
  • Physician Assistant (PA): CMS-855I only
  • Complete sections 1, 2, 3, 4B, 13, and 15 of CMS-855I
  • Physician Assistants (PAs) complete sections 1, 2, 2E, 13 and 15 of CMS-855I
  • List all reassignments, Provider Transaction Access Numbers (PTANs) and National Provider Identifiers (NPIs) in which provider will render services
  • Attach all supporting documentation such as Diploma and Certification
Organization
  • CMS-855B
  • CMS-588 EFT
  • CMS 460 (if applicable)

Organization must have at least one rendering provider

If provider not enrolled, submit CMS-855I and CMS-855R

If provider is actively enrolled, submit CMS-855R

To check if provider is enrolled, go to Data.CMS.gov This link will take you to an external website.

  • Complete all sections of CMS-855B
  • Attach all supporting documentation such as IRS document, CMS 588 EFT and voided check/bank letter
  • List all current, active practice locations
  • List all directors, board members and contracted or W-2 managing employee
  • Ensure someone is marked as a contracted or W-2 managing employee
  • Fees may be required. View Application Fee webpage to see if this applies
Sole Owner
  • CMS-855I
  • CMS-588 EFT
  • CMS 460 (if applicable)
  • Complete sections 1, 2, 3, 4A-4H, 6, 8, 13, and 15 of CMS-855I
  • Attach all supporting documentation such as Diploma, Internal Revenue Service (IRS) document, Certification, CMS-588 Electronic Funds Transfer (EFT) and voided check/bank letter
  • List all current, active practice locations
Sole Proprietor
  • CMS-855I
  • CMS-588 EFT
  • CMS 460 (if applicable)
  • Complete sections 1, 2, 3, 4C-4H, 6, 8, 13, and 15 of CMS-855I
  • Attach all supporting documentation such as Diploma, IRS document (if billing with EIN), Certification, CMS-588 EFT, voided check/bank letter
  • List all current, active practice locations

 

  • If provider has completed the e-signature process in PECOS, there is no need to sign and mail a paper signature as well
  • Ensure correspondence address is up to date and a location that is regularly monitored
  • If provider receives an email in regards to being active in another state and is still active in that state, it may be disregarded. However, if no longer providing services in those states, send an application to terminate. See Withdraw from Medicare webpage for details

What a Provider Should Expect After Application Submission

  • Application Processing Time
    • Initial paper application with onsite visit: 80-210 days
    • Initial paper application without onsite visit: 60-180 days
    • Initial web application with onsite visit: 80-120 days
    • Initial web application without onsite visit: 45-90 days
  • When a provider application is completed, a notification letter is sent. Letter will state whether application has been approved, rejected or denied
Application Status Brief Description
Approved

Provider may begin billing:

  • Enroll with Electronic Data Interchange (EDI) in order to bill electronically, visit EDISS This link will take you to an external website. for more information. Select the state you are enrolled in.
  • If there are any changes that must be made to the enrollment following approval, complete a new form with any changes within 30 days to avoid revocation.
Rejected Provider must start over with a new application, new signatures, etc.
Denied Provider doesn't meet qualifications Medicare has set and was not enrolled
  • Denial letter will provide instructions to appeal

 

CMS requires providers/suppliers to revalidate every five years. View the Revalidation webpage for details.

 

Last Updated Nov 16, 2017