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World of Medicare

Summary

  • The 6 steps to becoming a Medicare provider are:
    1. Register in the I&A System
    2. Get an NPI
    3. Enter information into PECOS
    4. Decide if you want to be a participating provider
    5. Check the status of your pending enrollment application
    6. Keep your enrollment information up to date
  • The I&A System lets you create 1 user account to manage access to CMS systems such as PECOS.
  • NPIs are:
    • 10-digit numeric identifiers that don’t change
    • Used in HIPAA standard transactions
    • Needed to enroll as a Medicare provider or supplier
  • PECOS is the preferred method for provider enrollment.
  • Enrolling as a Medicare provider involves completing Form CMS-855 or CMS-20134 for your provider type. The form and the information that it collects are the same whether you complete the paper form or use PECOS.
  • The IDM website offers CMS business partners a means to apply for, get approval, and get a single user id to access many CMS applications.
  • ACOs are groups of doctors, hospitals, and other health care providers who work together to provide coordinated, high-quality care for patients or clients enrolled in Medicare. Coordinated care makes sure patients or clients get the right care at the right time, while avoiding duplication of services and preventing medical errors.