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Medicare Provider Enrollment

Enrolling as a Provider using PECOS

This information was published in May 2014 by the Centers for Medicare & Medicaid Services within a document titled The Basics of Internet-based PECOS for Physicians and Non-Physician Practitioners (ICN 903764). Here is the link to go directly to the PECOS enrollment page:
PECOS Enrollment Website

Internet-based Provider Enrollment, Chain and Ownership System (PECOS) is an electronic Medicare enrollment system through which providers and suppliers can:

  • Submit Medicare enrollment applications;
  • View and print enrollment information;
  • Update enrollment information;
  • Complete the revalidation process;
  • Voluntarily withdraw from the Medicare Program;
  • Track the status of a submitted Medicare enrollment application.

There are four basic steps when enrolling in Medicare:

  1. Obtain a National Provider Identifier (NPI)
    You must obtain an NPI prior to applying for enrollment in the Medicare Program.

  2. Register in the Identity and Access Management System (I&A)
    You must obtain an I&A User ID and password to log in to PECOS.

  3. Enter enrollment data into Internet-based PECOS.

    • Enter enrollment data into Internet-based PECOS to electronically send your application to your Medicare enrollment contractor.

    • Internet-based PECOS determines your enrollment scenario after you complete a series of questions. Internet-based PECOS verifies you entered all required data and allows you to submit all enrollment materials electronically.

  4. Check the status of your pending enrollment application.

    • Check the status of your pending enrollment application to see the final decision.

    • Internet-based PECOS gives you an application status of Received, Reviewed, Returned, or Approved/Rejected.

Step 1 - Obtain a National Provider Identifier (NPI)

Physicians and NPPs must obtain an NPI prior to enrolling in the Medicare Program. You can apply for an NPI in one of three ways:

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Step 2 - Register in the Identity & Access Management System (I&A)

  1. Visit Internet-based PECOS on the CMS website.
  2. Under the “Become a Registered User” section, select the “Register for a User Account” option. (This will direct you to the PECOS I&A screen where you must register.)
  3. Create an I&A User ID and password as part of the registration process (if you don’t currently have one).
  4. Provide the requested information to CMS External User Services (EUS) Help Desk.
  5. The CMS EUS Help Desk verifies the information you furnished.
  6. If approved by the CMS EUS Help Desk, you’ll receive an email notification.

For more information on registering for an I&A account, including a quick reference guide, Frequently Asked Questions (FAQs), and tutorials, visit the CMS website.

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Step 3 - Enter Enrollment Data Into Internet-based PECOS

  1. Log in to Internet-based PECOS on the CMS website.

  2. Initiate an enrollment action by selecting an existing enrollment or creating a new application. Internet-based PECOS is a scenario-driven application – it presents a series of questions to retrieve only the information needed to process your specific enrollment scenario. Initially, you must select one of the application descriptions listed below. If you are reassigning all your benefits to a group practice or clinic, select “Group Member Only” (described below in the third bullet).

    • Sole Owner of a Professional Association (PA), Professional Corporation (PC), and Limited Liability Company (LLC) – You are the only owner of a business, set up as a corporation, through which you provide health care services. Your business is legally separate from your personal assets.

    • Self-Employed/Sole Proprietor – You provide all your health care services from a facility that you own, lease, or rent. You are the only owner of a business that provides health care services. You and your business are legally one and the same. You are personally responsible for any of the business’ financial obligations. You report the business’ income and losses on your personal tax return.

    • Group Member Only – You provide all of your health care services as an employee of a group practice or clinic. You have an arrangement with your employer to send in Medicare claims and get paid for the services you provide.

    • Group Member and Is Self-Employed – You provide health care services as an employee of a group practice or clinic. You have an arrangement with your employer to send in Medicare claims and get paid for the services you provide. You also provide health care services from a facility that you own, lease, or rent. The income you make through self-employment is part of your personal assets.

    • Disregarded Entity – You are the only owner of a business, set up as a corporation, through which you provide health care services. You and your business are considered legally one and the same.

  3. Once Internet-based PECOS determines your enrollment scenario and you confirm that it is correct, it displays the topics required for your application submission. To complete each topic, enter the required information by navigating through the displayed screens.

  4. At the end of the data entry process, Internet-based PECOS:

    • Ensures you entered all required data.

    • Allows you to print a copy of your enrollment application. We recommend you also print a copy for your records.

    • Displays a list of any other required documentation you must submit to the Medicare enrollment contractor.

    • Presents the option to electronically sign and certify the application or print the 2-page Certification Statement. If printed, you must sign (original signature, preferably in blue ink) and date the Certification Statement.

    • Displays the name and mailing address of the Medicare enrollment contractor.

    • Electronically transmits the enrollment application. (Users who submit an enrollment application using Internet-based PECOS should not mail a copy of the printed enrollment application to the Medicare enrollment contractor; this copy is for your records.)

    • Sends you an email indicating your enrollment application was successfully transmitted to the Medicare enrollment contractor. If you choose to mail the signed and dated paper Certification Statement, you must send it to the Medicare enrollment contractor in a timely manner(ideally within 1 week) for your application to be processed.

  5. Once your Internet-based PECOS application is electronically submitted, it is “locked,” meaning you cannot edit it unless your Medicare enrollment contractor returns the application to you for corrections through Internet-based PECOS.

  6. Your Medicare enrollment contractor will notify you if it requires additional information. To ensure timely processing, do not delay submitting the required supporting documentation, (if you chose not to use the digital document feature). A Medicare enrollment contractor will not begin, and may not complete, processing an Internet enrollment application without your electronic signature or signed and dated Certification Statement and required supporting documentation. In addition, your effective date of filing an enrollment application is the date the Medicare enrollment contractor receives your electronic signature or signed and dated Certification Statement.

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Step 4 - Check Status of Pending Enrollment Application

There are two ways to use Internet-based PECOS to check the status of your application:

  1. Log in to Internet-based PECOS and click on “View Enrollments.” Under the “Existing Enrollments” section, find the application. The status of the application will be displayed.

  2. On the Internet-based PECOS homepage, click on the “Application Status” link under the “Provider & Supplier Resources” section. There are four application statuses:

    • Received by the Medicare Enrollment Contractor – A user successfully submitted an electronic enrollment application to the Medicare enrollment contractor.

    • Reviewed by the Medicare Enrollment Contractor – The Medicare enrollment contractor is reviewing the enrollment application.

    • Returned for Additional Information – The Medicare enrollment contractor returned the application to the user for additional information.

    • Approved or Rejected – The Medicare enrollment contractor processed the enrollment application. The final status displays.

    NOTE: You do not have to be logged in to Internet-based PECOS to use this application status feature.

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For additional help with PECOS, download the Getting Started guide:
PECOS Getting Started Guide

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3/4/2015

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