Navigating Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS)

Posted on 30 Nov, 2018 |comments_icon 0|By Elizabeth

To file claims for reimbursement to Medicare, you must be a recognized Medicare provider or supplier, meaning that you must first enroll in Medicare. CMS gives you two enrollment options: You can take the paper route and fill out and submit by mail the CMS-855 form that pertains to, or best describes, you (see the list below). Or, you can enroll in Medicare through PECOS, CMS’s Internet-based enrollment portal.

Enrolling in Medicare through PECOS has advantages, least of all that you’ll become familiar with the online portal, which will serve you in other tasks, such as tracking the status of your enrollment application, updating your enrollment information, completing the enrollment revalidation process, or adding an authorized official (AO) who can work within the CMS systems to perform any of these tasks on your behalf.

But before we explore PECOS enrollment, let’s begin with CMS-855, your paper option.

Choosing the Paper Enrollment Process

Enrolling with Medicare involves identifying the appropriate CMS-855 form(s), as you have eight forms from which to choose, each one geared to a specific provider/supplier of healthcare services or products. The CMS Forms List provides access to all of the following eight CMS-855 forms, as well as summarizes to whom the various forms pertain:

  • CMS-855A (institutional providers)
  • CMS-855B (clinics, group practices, and certain other suppliers)
  • CMS-855I (physicians and non-physician practitioners)
  • CMS-855R (reassignment of Medicare benefits)
  • CMS-855O (eligible ordering and referring physicians and non-physician practitioners)
  • CMS-855S (suppliers of durable medical equipment, prosthetics, orthotics, supplies (DMEPOS))
  • CMS-855POH (physician owned hospitals)
  • CMS-20134 (suppliers of Medicare Diabetes Prevention Program (MDPP)).

From the above links, you can view a selected form in your Internet browser. You’ll find that the form includes an introductory page to help you confirm that you’ve selected the appropriate enrollment application. We recommend that you review this page, entitled “Who Should Submit This Application,” before investing effort in the enrollment process. Then, once you’re sure you have the correct form, you can download the PDF file to your computer.

Tip: You might choose to print the document and read it thoroughly before beginning the actual work of completing your application. Taking this extra step is advisable, particularly if you’re a first-time enrollee or it’s been a while since you’ve submitted a CMS-855. Reviewing the instructions, as well as the numerous form fields, will clue you in to what information you’ll need and may save you valuable time.

You have the option to fill out the form by hand, though the form is conveniently designed for you to type directly into each field using Adobe Acrobat. To ensure your document is legible — and avoid errors that could delay your enrollment — CMS encourages you to submit a typed application. The one exception, of course, is the required signature fields, which must be filled in by hand.

Once you fill out all the application fields, you’ll find a list of supporting documents that must accompany your application. After you’ve gathered these, you’re good to go.

Mail your completed application and all supporting documentation to the Medicare fee-for-service contractor serving your state or geographic location. If you don’t know your contractor’s address, you’ll find it at CMS’s Medicare Fee-For-Service Contact Information.

Caution: Do not mail your enrollment packet to CMS in Baltimore, Maryland, as this will delays the processing of your application.

Check and Double-check Prior to Mailing

  • Complete all required sections of your CMS-855 form.
  • Enter your NPI in all applicable sections.
  • Enter all applicable dates.
  • Don’t forget to append the require handwritten signatures.
  • Include all required supporting documentation in your packet.
  • Make a copy of your signed form to keep in your records.

Note: Once filed, your enrollment application must be maintained and updated. Medicare periodically requires all healthcare providers to revalidate, or resubmit their CMS-855 forms, to ensure compliance (usually once every five years). To learn when you’re due for revalidation, check the Medicare Revalidation Lookup Tool. Your Medicare Administrative Contractor (MAC) will also send you a notice.

Going Paperless in the Digital Age

Using PECOS, Medicare’s online enrollment option, allows providers and suppliers to securely submit and manage their enrollment information electronically. Among its many advantages, PECOS will walk you through the process step by step, ensuring you detail all relevant information and don’t waste time on the irrelevant bits. With PECOS overseeing the process, you no longer need to check and double-check or follow up on incomplete applications, as PECOS will alert you to oversights.

Choosing to go with PECOS, though, requires an initial step. Providers and suppliers must become registered users by creating an Identity & Access Management (I&A) System account, which basically entails setting up login information that will then grant you access to PECOS and other online tools.

Learn More

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Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of telehealth services.

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