Target Audience: Medicare Fee-For-Service Providers
Use the resources in this educational tool to learn how to enroll in the Centers for Medicare & Medicaid Services (CMS) Medicare Program, revalidate your enrollment, or change your enrollment information. You must enroll in the Medicare Program to get payment for covered services you provide to Medicare beneficiaries. You must enroll if you solely order items or certify services, and you will not submit claims for these services.
You can enroll online by using the Provider Enrollment, Chain, and Ownership System (PECOS) or the appropriate paper enrollment application submitted to a Medicare Administrative Contractor (MAC). CMS wants providers to use PECOS instead of the paper Medicare enrollment application. First get an Identity & Access Management (I&A) System user account. Second, apply in the National Plan and Provider Enumeration System for your National Provider Identifier (NPI). Finally, enroll in PECOS.
To explain a term, select the “Commonly Used Terms” button.
Enroll in Medicare
Medicare enrollment varies for each provider or supplier type. This tool sends you to the enrollment forms, process descriptions, and resources appropriate to your provider or supplier type.
|Provider-Supplier General Information||Medicare Provider-Supplier Enrollment|
|Institutional Providers||Medicare Enrollment for Institutional Providers|
|Ordering or Certifying Providers||Medicare Enrollment for Providers Who Soley Order or Certify|
|Physicians, Non-Physician Practitioners (NPPs), and Other Part B Suppliers||Medicare Enrollment for Physicians, NPPs, and Other Part B Suppliers|
|Reporting Changes||Timely Reporting of Provider Enrollment Information Changes|
|Revalidation Due Dates||Medicare Revalidation Lookup Tool|
PECOS is an online Medicare enrollment system where providers and suppliers can:
- Submit Medicare enrollment applications
- View and print enrollment information
- Update enrollment information
- Complete the enrollment revalidation process
- Withdraw from the Medicare Program voluntarily
- Track the status of a submitted Medicare enrollment application
|Online Enrollment System||PECOS System|
|PECOS Tutorials||PECOS Enrollment Tutorial Videos|
|Frequently Asked Questions (FAQs)||PECOS FAQs|
|Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Information||PECOS for DMEPOS Suppliers|
|Physician and NPP Information||PECOS for Physicians and NPPs|
|Provider and Supplier Organizations Information||PECOS for Provider and Supplier Organizations|
|Technical Assistance||PECOS Technical Assistance Contact Information|
|PECOS Protects Your Personal Information||Safeguard Your Identity and Privacy Using PECOS|
|Submit provider National Provider Identifier (NPI) Applications and Update Information Electronically in NPPES||Electronic File Management Main Page|
|Register for Usernames and Passwords to Access NPPES, PECOS, and the EHR Incentive Program|
|Get an NPI|
|Search NPI Records, Including the Provider’s Name, Specialty, and Practice Address||NPPES NPI Registry|
Protect Your Identity and Information
NPIs and Tax IDs are publicly available information. Use extra caution to monitor and protect professional and personal information to help prevent fraud and abuse. Secure your patients’ personal health information, too. CMS has the following resources:
You may have questions or problems that need additional assistance or technical support.
|Navigating/Accessing PECOS Website|
|Paper Applications, Questions on Application Not Related to PECOS||Medicare Fee-For-Service Provider Enrollment Contact List|
|Application for NPI||NPPES Home Page/Sign In Page Help|
|Institutional Provider Site Visit||National Site Visit Contractor (NSVC)|
|Institutional and Other Providers State Survey||State Survey Agency Directory|
|All Other Enrollment-Related Questions||Contact your MAC|
Medicare makes enrollment forms available as fillable PDF files. If you choose to enroll using a paper application instead of PECOS, search the CMS Forms List for the form you need, select a form, and read “Who Should Complete This Application” on page 1 of the CMS-855 form. Check to ensure you use the correct application.
|Electronic Funds Transfer (EFT) Authorization Agreement||CMS-588|
|Medicare Enrollment Application: Clinics/Group Practices and Certain Other Suppliers||CMS-855B|
|Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers||CMS-855S|
|Medicare Enrollment Application: Eligible Ordering, Certifying, and Prescribing Physicians and Other Eligible Professionals||CMS-855O|
|Medicare Enrollment Application: Institutional Providers||CMS-855A|
|Medicare Enrollment Application: Physicians and Non-Physician Practitioners||CMS-855I|
|Medicare Enrollment Application: Reassignment of Medicare Benefits||CMS-855R|
|Medicare Participating Physician or Supplier Agreement||CMS-460|
|National Provider Identifier (NPI) Application/Update Form||CMS-10114|
Commonly Used Terms
For a complete list of terms, go to the CMS Glossary.
- Centers for Medicare & Medicaid Services (CMS)
- CMS is the Federal agency that administers the Medicare, Medicaid, State Children’s Health Insurance Program (CHIP), Health Insurance Portability and Accountability Act of 1996 (HIPAA), Clinical Laboratory Improvement Amendments (CLIA), and several other health-related programs.
- Medicare Participating Physician or Supplier Agreement describes your willingness to accept assignment for all covered services you provide to Medicare beneficiaries. If you participate, Medicare pays 5 percent more. Participating providers get direct and timely Medicare payment.
- Electronic Funds Transfer (EFT) Authorization Agreement tells you how to get electronic payments or update existing banking information.
- The Medicare Enrollment Application Institutional Providers use to enroll, revalidate enrollment, or change enrollment information.
- The Medicare Enrollment Application Clinics/Group Practices and Certain Other Suppliers, except Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers use to enroll, revalidate enrollment, or change enrollment information.
- The Medicare Enrollment Application Physicians and Non-Physician Practitioners (NPPs) (Individual physicians or NPPs) use to enroll, revalidate enrollment, or change enrollment information.
- 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 Medicare beneficiary services. This includes those physicians and other eligible NPPs who do not and will not send furnished beneficiary services claims to a Medicare Administrative Contractor (MAC).
- Medicare Enrollment Application is the form used to make Reassignment of Medicare Benefits. It tells you how to request a reassignment of a right to bill the Medicare Program and get Medicare payments. Only individual physicians and NPPs can reassign their right to bill the Medicare Program.
- Medicare Enrollment Application is the form used by Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers to enroll in Medicare, revalidate enrollment, or change enrollment information.
- The National Plan Identifier (NPI) Application/Update Form tells you how to apply or submit updates for an NPI.
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
- Entities or individuals, including physicians or Part A providers, that sell or rent Medicare Part B covered items to beneficiaries 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)
- Medicare directly pays EFT providers by sending payments to the provider’s financial institution whether they file claims electronically or on paper. All Medicare 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
- The EUS is a dedicated CMS systems online support site that provides help including, but not limited to, the Identity & Access Management (I&sA) System; Provider Enrollment, Chain, and Ownership System (PECOS); and National Plan and Provider Enumeration System (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 non-physician practitioner organizations), or CMS-855S form. See page 1 of the respective provider-type forms about who should use them.
- Medicare Administrative Contractor (MAC)
- This is a private company that contracts with Medicare to process and pay Medicare Fee-For-Service beneficiary Part A and Part B (A/B) medical or Durable Medical Equipment (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. CMS defines “institutional provider” as any provider or supplier that submits a CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S form.
- National Plan and Provider Enumeration System (NPPES)
- NPPES assigns unique health care providers and health plans National Provider Identifiers (NPIs). NPIs improve the efficiency and effectiveness of electronically submitting health information.
- National Provider Identifier (NPI) Registry
- NPI 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.
- National Site Visit Contractor (NSVC)
- NSVC performs a site visit to screen and stop questionable providers and suppliers from enrolling or maintaining enrollment.
- NPI Enumerator
- The NPI Enumerator helps health care providers apply for NPIs and update their information in the National Plan and Provider Enumeration System (NPPES). (See NPI Registry)
- Participating Physician or Supplier
- A participating physician or supplier agrees to accept furnished beneficiary Medicare services claims assignment. They agree to accept Medicare-allowed amounts as payment in full and to collect only Medicare beneficiary deductibles and coinsurance. (See CMS-460)
- Provider Enrollment, Chain, and Ownership System (PECOS)
- PECOS is CMS’ online provider enrollment system. PECOS allows registered users to securely and electronically submit and manage Medicare enrollment information. You can use PECOS instead of Medicare paper enrollment forms.
- Reassignment of Medicare Benefits
- Reassigning your Medicare benefits lets an eligible organization or group submit claims and receive payment for Medicare Part B services you provide as a member of the organization or group. (See CMS-855R)
- The provider or supplier mandatory resubmission and recertification process to maintain enrollment information accuracy and Medicare billing privileges. The process confirms the Medicare enrollment information on file remains complete and up to date and helps fight health care fraud.
- State Survey Agency
- Performs initial surveys and periodic resurveys of all institutional providers (including laboratories) and certain kinds of suppliers. These surveys determine whether 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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