Medicare Provider Enrollment Print

We list institutional providers on the Medicare Enrollment Application: Institutional Providers (CMS-855A), which include:

• Community mental health centers
• Comprehensive outpatient rehabilitation facilities
• Critical access hospitals
• ESRD facilities
• Federally Qualified Health Centers
• Histocompatibility labs
• Home health agencies
• Hospice organizations
• Hospitals
• Indian Health Service facilities
• Organ procurement organizations
• Opioid treatment programs
• Outpatient physical therapy, occupational therapy, speech pathology services
• Religious nonmedical health care institutions
• Rural emergency hospitals
• Rural health clinics
• Skilled nursing facilities (SNFs)

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).

If you don’t see your provider type listed, contact your MAC’s provider enrollment center before submitting a Medicare enrollment application.

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:

• ASCs
• Hospices
• Hospitals
• Medical group practices and clinics
• Portable X-ray suppliers
• SNFs

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).

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.

Medicare Claims Processing Manual, Chapter 12 has more information.

Enrolling physicians, NPPs, or other Part B suppliers must choose 1 of the application descriptions below.

• Sole Owner of a Professional Association (PA), Professional Corporation (PC), or Limited Liability Company (LLC):
  • You’re the only owner of a business, set up as a corporation, where you provide health care services
  • Your business is legally separate from your personal assets
• Self-Employed or Sole Proprietor:
  • You provide all health care services from a facility you own, lease, or rent
  • You’re the only owner of a business that provides health care services
  • You and your business are legally 1 and the same
  • You’re personally responsible for the business’ financial obligations, and you report business income and losses on your personal tax return
• Group Member Only:
  • You provide all health care services as an employee of a group practice or clinic
  • You arrange with your employer to submit claims and get paid for your services
  • Choose Group Member Only if you’re reassigning all your benefits to a group practice or clinic
• Group Member and Self-Employed:
  • You provide health care services as a group practice or clinic employee
  • You agree with your employer to submit claims and get paid for your services
  • You also provide health care services from a facility that you own, lease, or rent
  • Your income through self-employment is part of your personal assets
• Disregarded Entity:
  • You’re the only owner of a business, set up as a corporation, where you provide health care services
  • Your corporation doesn’t file taxes; instead, you file corporate taxes on your personal tax filing

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.

• Medicare Enrollment Application: Physicians and Non-Physician Practitioners (CMS-855I): Individual physicians or NPPs, as well as individual physicians and NPPs that are sole proprietors or sole owners of a corporation that provides services, use this form to begin the Medicare enrollment or revalidation process or to change enrollment information.
  

  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.

• Medicare Enrollment Application: Clinics/Group Practices and Other Suppliers (CMS-855B): Group practices and other organizational suppliers, except DMEPOS suppliers, use this form to begin the Medicare enrollment or revalidation process or to change enrollment information.
• Medicare Enrollment Application: Enrollment for Eligible Ordering/Certifying Physicians and Other Eligible Professionals (CMS-855O): Physicians and other eligible NPPs use this form to enroll in Medicare solely to order or certify items or services for Medicare patients. This includes those physicians and other eligible NPPs who don’t send billed services claims to a MAC.
• Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (CMS-855S): DMEPOS suppliers use this form to begin the Medicare enrollment or revalidation process or to change enrollment information.
• Medicare Enrollment Application: Medicare Diabetes Prevention Program (MDPP) Suppliers (CMS-20134): MDPP suppliers use this form to begin the Medicare enrollment or revalidation process or to change enrollment information.

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.

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.

We use several provider enrollment systems. Specifically, the I&A System allows you to:

• Use NPPES to apply for and manage NPIs
• Use PECOS to enroll in Medicare or to update or revalidate your current enrollment information
• Register to get EHR incentive payments for eligible professionals and hospitals that adopt, use and upgrade, or show meaningful use of certified EHR technology

Before completing PECOS enrollment, create an I&A System account. Organizational providers and suppliers must designate an AO to work in these systems.

Use the same information to enroll in Medicare using PECOS as you would for a paper enrollment application.

• If you don’t have an I&A System account, create your username and password
• Use your username and password to log in to NPPES to register for an NPI
• All Medicare provider enrollees must have an active NPI

Based on your provider type, you may also need this information:

• Personal identifying information, including your legal name on file with the Social Security Administration, date of birth, and SSN
• Legal business name of the provider or supplier organization
• Provider or supplier organization’s TIN; if any person or organization has 5% or more partnership interest or ownership (direct or indirect), you must list them on all enrollment records under your TIN
• Professional information, like:
  • Professional license information
  • School degrees
  • Certificates
• W-2 employees and contracted individuals and organizations with managerial control of the provider or supplier
• Accreditation information
• Surety bond information
• Specialty and secondary specialty information
  • Providers self-designate their Medicare specialty on the Medicare enrollment application (CMS 855-I or CMS 855-O) or PECOS when they enroll in the Medicare Program
  • Beginning January 1, 2024, we established new provider specialty codes for dentists
• Practice location information, including:
  • Current medical practice location
  • Federal, state, and local (city or county) business and professional licenses, certificates, and registrations specifically required to operate as a health care facility
  • Medical record storage information
  • Special payment information
• Bank account information
• Information about relevant final adverse actions by a provider, supplier, owner, managing organization, officer, director, authorized or delegated official, medical director, supervising physician, or other health care or administrative or management services personnel, which may include:
  • Suspension, termination, or revocation of a license to provide health care by a state licensing authority or the Medicaid Program
  • Conviction of a federal or state felony within 10 years before enrollment, revalidation, or re-enrollment
  • Exclusion or debarment from federal or state health care program participation by the Office of Inspector General (OIG) or other federal or state offices with authority to exclude or sanction a provider (or those listed above)

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.

You can’t use PECOS to:

• Change your SSN
• Change a provider’s or supplier’s TIN
• Change an existing business structure, for example:
  • Solely owned PA, PC, or LLC can’t be changed to a sole proprietorship
  • Sole proprietorship can’t be changed to a PA, a PC, or an LLC

Submit changes noted above using the appropriate paper Medicare enrollment application.

No. All Fee-for-Service (FFS) providers can apply in PECOS.

PECOS is available 24 hours a day, Monday–Saturday, with scheduled downtime on Sunday. We offer technical support daily, 5 am–8 pm CT.

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:

• Parts A and B Providers: Send forms to your Part A or Part B MAC.
• Home Health and Hospice Providers: Send forms to the Home Health and Hospice Contractor.
• DMEPOS Suppliers Send forms to the National Provider Enrollment (NPE) DMEPOS contractor in your region. Find your NPE contractor.

Even if you submit your application on a paper form, your MAC creates an enrollment record in PECOS.

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.

Create a new enrollment:

• If you change your services, like changing specialties
• If you change your location, causing your MAC to need new state surveys and other documentation (your MAC can determine this)
• If you have a change of ownership
• If a provider is creating a new TIN because of a change of ownership
• If you have provider-based vs. freestanding requirements (find your MAC’s website for more information)

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.

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.

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.

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.

Yes, either is acceptable. You must send this information electronically (as supporting documentation uploaded into 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.

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.

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.

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.

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.

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.

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).

Providers and suppliers should report most changes using PECOS or the applicable paper Medicare enrollment application.

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.

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.

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.

Due dates are:

• Updated in the Medicare Revalidation List every 60 days at the beginning of the month
• Listed up to 7 months in advance or listed as to be determined (TBD) if the due date is more than 7 months away

Yes. Your MAC will send a revalidation notice 90–120 days before your revalidation due date.

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.

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.

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.

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.