The Medicare enrollment applications have some updates (CMS-855 or Internet-based Provider Enrollment, Chain and Ownership System (PECOS)) is an Office of Management and Budget approved forms and are available in PDF fillable formats. These formats allow a user to complete an application using Adobe Acrobat and save this information on their personal computer. Please refer to the CMS Forms List link below:
- CMS-855A: Medicare Enrollment Application for Institutional Providers
- CMS-855B: Medicare Enrollment Application for Clinics, Group Practices, and Certain Other Suppliers
- CMS-855I: Medicare Enrollment Application for Physicians and Non-Physician Practitioners
- CMS-855R: Medicare Enrollment Application for Reassignment of Medicare Benefits
- CMS-855O: Medicare Enrollment Application for Eligible Ordering and Referring Physicians and Non-physician Practitioners
- CMS-855S: Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
- CMS-20134: Medicare Enrollment Application for Medicare Diabetes Prevention Program (MDPP) Suppliers
All physicians and other qualified healthcare experts (as defined in section 1848(k) (3) (B) of the Social Security Act) must use the CMS-855I (or PECOS) to enroll in the Medicare program and receive a Medicare billing number.
Keep in mind that typed forms are easier for Medicare to process. But in some cases the most efficient method for submitting your enrollment application is to use the Internet – Based Provider Enrollment, Chain and Ownership System (PECOS). This guides you through the enrollment application. So, it’s easy to supply information relevant to your application. Using Internet-based PECOS results in a more accurate application and saves your time and administrative cost.
By submitting a Medicare enrollment application, a physician provider or other supplier will establish an enrollment record in PECOS. For physicians and eligible non-physician practitioners, this means that your name and National Provider Identifier (NPI) will be added to the Ordering and Referring Report during the next update cycle.
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ADDITIONAL FORMS:
The following forms are routinely submitted with an enrollment application:
- Electronic Funds Transfer (EFT) Authorization Agreement (Form CMS-588)
- Medicare Participating Physician or Supplier Agreement (Form CMS-460)
Source: CMS
