Q. What is PECOS?
A. The Provider Enrollment, Chain and Ownership System (PECOS) is a national database of Medicare provider, physician, and supplier enrollment information. PECOS is used to collect and maintain the data submitted on CMS-855 enrollment forms.
Q: How do I know which provider enrollment application to use?
A: You may either use the Provider Enrollment, Chain, and Ownership System (PECOS) external link to enroll online or mail a paper application form. PECOS supports the Medicare provider and supplier enrollment process by capturing provider/supplier information from the CMS-855 family of forms. The system manages, tracks, and validates enrollment data collected in both paper form and electronically via the Internet.
• Institutional providers: CMS-855A
• Clinics/group practices and certain other suppliers: CMS-855B
• Physicians and non-physician practitioners (including clinical psychologists): CMS-855I
• Reassignment of benefits: CMS-855R
• Ordering/referring providers: CMS-855O
Note: Ordering/referring providers must meet the criteria specified by SE 1305 external pdf file
• Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers: CMS-855S
Note: CGS Medicare external link is the DMEPOS Medicare Administrative Contractor (MAC) for Florida, Puerto Rico, and the U.S. Virgin Islands.
Q: I used the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) to enroll online. When do I need to send my certification statement and supporting documentation to my assigned Medicare contractor?
A: Internet-based PECOS allows providers to provide signatures and documents via hard copy or electronic copy.
If electronic signature (e-signature) and uploading documents are chosen, the tasks are completed within Internet-based PECOS at the time the application is being completed.
If e-signature and uploading documents are not chosen, the hard copies must be mailed to your assigned Medicare contractor as quickly as possible. First Coast Service Options Inc. (First Coast) is the assigned Medicare administrative contractor (MAC) for Florida, Puerto Rico, and the U.S. Virgin Islands.
The Centers for Medicare & Medicaid Services (CMS) has established the timeliness requirement for a signed and dated certification statement to be submitted to the assigned Medicare contractor within 15 days of the submission of the PECOS application
Note: If a provider fails to submit the signed and dated certification statement within CMS’ specified timeframe, contractors are required to reject the provider’s Internet-based PECOS application. Copies of the certification statement will not be accepted, and blue ink is recommended.
Q: I am a clinical psychologist. Do I need to complete a special Medicare enrollment application?
A: If you are a clinical psychologist or a psychologist who bills independently, you have two options:
• Use the Provider Enrollment, Chain, and Ownership System (PECOS) external link to enroll online.
Note: PECOS supports the Medicare provider and supplier enrollment process by capturing provider/supplier information from the CMS-855 family of forms. The system manages, tracks, and validates enrollment data collected in both paper form and electronically via the Internet.
• Complete and mail the Physicians and non-physician practitioners enrollment application form: CMS-855I external pdf file.
Note: Community mental health centers should use the enrollment application form for institutional providers: CMS-855A external pdf file.
Q: When do I need to complete a new CMS-855?
A. You need to complete a new CMS-855 when:
• An individual or entity is requesting initial enrollment into the Medicare program.
• Changes are being submitted to update enrollment information and the individual or entity does not have a completed enrollment application (CMS-855) on file.
• An individual or entity is submitting a request for Electronic Funds Transfer (EFT) and an enrollment application is not on file.
Note: For more information about revalidation requests, please refer to our Revalidations FAQs.
Q: Can I enroll in Medicare or change my enrollment information online?
A: Yes. The Provider Enrollment, Chain and Ownership System (PECOS), which is used to collect and maintain the data submitted on CMS-855 enrollment forms, is available online at https://pecos.cms.hhs.gov/pecos/login.do external link.
Q: Where do I mail my provider enrollment application?
A: You may mail your completed paper application to your assigned Medicare administrative contractor (MAC). First Coast Service Options Inc. (First Coast) is the MAC assigned to jurisdiction N (JN), which encompasses Florida, Puerto Rico, and the U.S. Virgin Islands. If you are located within JN, please mail your completed provider enrollment application to the following address:
Provider Enrollment
P.O. Box 44021
Jacksonville, FL 32231-4021
Q: What happens to my application if it is submitted and is found to be incomplete?
A: When an incomplete application is submitted or is missing documents, the provider enrollment specialist will send a letter, send a fax or contact you by telephone outlining the missing information or attachment(s). For missing information on the CMS-855 application, the corrected sections of the application along with a new certification statement must be signed by an authorized official. This information can be faxed back to us since we have your original signature on file. If we are only missing supporting documentation the provider does not need to submit a new certification. You are only required to fax us copies of the missing documentation (e.g., copy of your Internal Revenue Service (IRS) CP-575 form).
Q: What is the purpose of the Medicare Participating Physician or Supplier Agreement (CMS-460)?
A: New physicians, practitioners, and suppliers may submit the CMS-460 form external pdf file at the time of their enrollment. Participants agree to accept assignment for all covered services provided to Medicare patients.
In addition, the CMS-460 may also used for existing providers during the annual participation open enrollment. The annual physician and supplier participation period begins January 1 of each year, and runs through December 31. The annual participation enrollment is scheduled to begin on November 15 of each year. (Note: The dates listed for release of the participation enrollment/fee disclosure material are subject to publication of the annual Final Rule.)
Q: How do I change my address or update other provider enrollment information (e.g., practice name or change of ownership)?
A: Address changes and provider file updates must be submitted on the proper Centers for Medicare & Medicaid Services (CMS) form, depending on the type of provider/supplier, or through Internet-based Provider Enrollment, Chain and Ownership System (PECOS). A CMS-855I is required for an individual, a CMS-855B is required for an organization, and a CMS-855A is required for institutional providers. For more information, refer to the Provider/supplier enrollment applications section of the First Coast Service Options Inc. (First Coast) provider website. This page provides an overview of provider-supplier enrollment, as well as links to enrollment applications.
Q: I submitted an application to change my address. What should I do to check the status of my enrollment application?
A: Providers may check the status of their enrollment applications through First Coast Service Options’ (First Coast’s) online lookup or through First Coast’s interactive voice response (IVR) system:
• Enrollment status lookup -- use this application to check the status of your enrollment in the Medicare program. You may search for pending applications by entering your national provider identifier (NPI) and provider transaction access number (PTAN) or check the status of a specific application by entering the 12-digit correspondence control number (CCN) and three-digit record number (listed in your acknowledgement letter).
• IVR system:
• Part A: Call 1-877-602-8816 and select option-7
• Part B: Call 1-877-847-4992 and select option-7
Q: What is the provider’s legal business name that should appear on CMS-855 Medicare enrollment applications?
A: A provider’s legal business name is the name that is registered with the Internal Revenue Service (IRS) and should appear on IRS documents, such as the CP-575, that contains a provider’s employee identification number (EIN) or tax identification number (TIN).
The provider’s legal business name with the IRS should identically match (including any or no punctuation) the business name registered with the National Plan & Provider Enumeration System (NPPES), which issues the national provider identifier (NPI). This is the information that will be loaded into the Provider Enrollment, Chain and Ownership System (PECOS). PECOS and NPPES must match exactly.
To validate that the legal business name the IRS has for you matches the business name registered with NPPES by visiting the NPPES website external link or contacting them at 1-800-465-3203 or 1-800-692-2326 for TTY services.
Q: What are the differences in completing Section 4 of a CMS-855I application for a sole proprietor versus a sole owner?
A: Sole Proprietorship - Section 4F of the CMS-855I is completed with the employer identification number (EIN). The instructions in this section state, “if you are a sole proprietor and you want Medicare payments to be reported under your EIN, list it below.” Only one national provider identifier (NPI) number is needed for the provider. Sole proprietors do not complete section 4A.
Sole Ownership - Section 4A of the CMS-855I is completed with the tax identification number (TIN). If anything is listed in section 4A, a separate NPI number must be obtained for the group number that will be assigned and listed in section 4A. The individual’s NPI number and information must be listed in section 4C.
CMS recently made available a document that will assist physicians and non-physician practitioners in completing the CMS-855I form titled Medicare Provider Enrollment of Individuals (Physicians and Non-Physician Practitioners) external pdf file. Scenarios 2a, 2b, 3 & 4 are very helpful in determining if you are a sole proprietor or sole owner.
Q: What information should be in Section 4 of the CMS-855R form?
A. The following information is required:
Initial Reassignment
Section 4A on page 6 is signed and dated by the person reassigning their benefits. Section 4B is signed and dated by the group’s authorized official or delegated official. If either signature is missing, First Coast Service Options, Inc. (First Coast) will return the application.
Terminating Reassignments
If the individual terminates a reassignment, the individual signs and dates section 4A.
If the organization terminates a reassignment, the group’s authorized official or delegated official signs and dates Section 4B.
For terminations, both signatures are not required. However, if no signatures are present, First Coast will return the application.
Applicable to all CMS-855R applications
The authorized or delegated official who signs section 4B must be currently on file with First Coast. All signatures must be original, preferably in blue ink. Faxed, stamped, or photocopied signatures cannot be accepted.
If the application is not signed and dated appropriately, the application will be returned. The application will need to be corrected and resubmitted. Any application resubmission must contain a brand new authorization page with proper signatures and dates. The provider cannot simply add its signature to the original authorization it submitted.
On December 3, CMS issued a notice: Provider Enrollment Application Fee Amount for Calendar Year 2016 [CMS–6066–N] (http://go.usa.gov/ckj8Z external link). Effective January 1, 2016, the calendar year (CY) 2016 application fee is $554 for institutional providers that are:
• Initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP)
• Revalidating their Medicare, Medicaid, or CHIP enrollment• Adding a new Medicare practice location
This fee is required with any enrollment application submitted from January 1 through December 31, 2016.
A. The Provider Enrollment, Chain and Ownership System (PECOS) is a national database of Medicare provider, physician, and supplier enrollment information. PECOS is used to collect and maintain the data submitted on CMS-855 enrollment forms.
Q: How do I know which provider enrollment application to use?
A: You may either use the Provider Enrollment, Chain, and Ownership System (PECOS) external link to enroll online or mail a paper application form. PECOS supports the Medicare provider and supplier enrollment process by capturing provider/supplier information from the CMS-855 family of forms. The system manages, tracks, and validates enrollment data collected in both paper form and electronically via the Internet.
• Institutional providers: CMS-855A
• Clinics/group practices and certain other suppliers: CMS-855B
• Physicians and non-physician practitioners (including clinical psychologists): CMS-855I
• Reassignment of benefits: CMS-855R
• Ordering/referring providers: CMS-855O
Note: Ordering/referring providers must meet the criteria specified by SE 1305 external pdf file
• Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers: CMS-855S
Note: CGS Medicare external link is the DMEPOS Medicare Administrative Contractor (MAC) for Florida, Puerto Rico, and the U.S. Virgin Islands.
Q: I used the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) to enroll online. When do I need to send my certification statement and supporting documentation to my assigned Medicare contractor?
A: Internet-based PECOS allows providers to provide signatures and documents via hard copy or electronic copy.
If electronic signature (e-signature) and uploading documents are chosen, the tasks are completed within Internet-based PECOS at the time the application is being completed.
If e-signature and uploading documents are not chosen, the hard copies must be mailed to your assigned Medicare contractor as quickly as possible. First Coast Service Options Inc. (First Coast) is the assigned Medicare administrative contractor (MAC) for Florida, Puerto Rico, and the U.S. Virgin Islands.
The Centers for Medicare & Medicaid Services (CMS) has established the timeliness requirement for a signed and dated certification statement to be submitted to the assigned Medicare contractor within 15 days of the submission of the PECOS application
Note: If a provider fails to submit the signed and dated certification statement within CMS’ specified timeframe, contractors are required to reject the provider’s Internet-based PECOS application. Copies of the certification statement will not be accepted, and blue ink is recommended.
Q: I am a clinical psychologist. Do I need to complete a special Medicare enrollment application?
A: If you are a clinical psychologist or a psychologist who bills independently, you have two options:
• Use the Provider Enrollment, Chain, and Ownership System (PECOS) external link to enroll online.
Note: PECOS supports the Medicare provider and supplier enrollment process by capturing provider/supplier information from the CMS-855 family of forms. The system manages, tracks, and validates enrollment data collected in both paper form and electronically via the Internet.
• Complete and mail the Physicians and non-physician practitioners enrollment application form: CMS-855I external pdf file.
Note: Community mental health centers should use the enrollment application form for institutional providers: CMS-855A external pdf file.
Q: When do I need to complete a new CMS-855?
A. You need to complete a new CMS-855 when:
• An individual or entity is requesting initial enrollment into the Medicare program.
• Changes are being submitted to update enrollment information and the individual or entity does not have a completed enrollment application (CMS-855) on file.
• An individual or entity is submitting a request for Electronic Funds Transfer (EFT) and an enrollment application is not on file.
Note: For more information about revalidation requests, please refer to our Revalidations FAQs.
Q: Can I enroll in Medicare or change my enrollment information online?
A: Yes. The Provider Enrollment, Chain and Ownership System (PECOS), which is used to collect and maintain the data submitted on CMS-855 enrollment forms, is available online at https://pecos.cms.hhs.gov/pecos/login.do external link.
Q: Where do I mail my provider enrollment application?
A: You may mail your completed paper application to your assigned Medicare administrative contractor (MAC). First Coast Service Options Inc. (First Coast) is the MAC assigned to jurisdiction N (JN), which encompasses Florida, Puerto Rico, and the U.S. Virgin Islands. If you are located within JN, please mail your completed provider enrollment application to the following address:
Provider Enrollment
P.O. Box 44021
Jacksonville, FL 32231-4021
Q: What happens to my application if it is submitted and is found to be incomplete?
A: When an incomplete application is submitted or is missing documents, the provider enrollment specialist will send a letter, send a fax or contact you by telephone outlining the missing information or attachment(s). For missing information on the CMS-855 application, the corrected sections of the application along with a new certification statement must be signed by an authorized official. This information can be faxed back to us since we have your original signature on file. If we are only missing supporting documentation the provider does not need to submit a new certification. You are only required to fax us copies of the missing documentation (e.g., copy of your Internal Revenue Service (IRS) CP-575 form).
Q: What is the purpose of the Medicare Participating Physician or Supplier Agreement (CMS-460)?
A: New physicians, practitioners, and suppliers may submit the CMS-460 form external pdf file at the time of their enrollment. Participants agree to accept assignment for all covered services provided to Medicare patients.
In addition, the CMS-460 may also used for existing providers during the annual participation open enrollment. The annual physician and supplier participation period begins January 1 of each year, and runs through December 31. The annual participation enrollment is scheduled to begin on November 15 of each year. (Note: The dates listed for release of the participation enrollment/fee disclosure material are subject to publication of the annual Final Rule.)
Q: How do I change my address or update other provider enrollment information (e.g., practice name or change of ownership)?
A: Address changes and provider file updates must be submitted on the proper Centers for Medicare & Medicaid Services (CMS) form, depending on the type of provider/supplier, or through Internet-based Provider Enrollment, Chain and Ownership System (PECOS). A CMS-855I is required for an individual, a CMS-855B is required for an organization, and a CMS-855A is required for institutional providers. For more information, refer to the Provider/supplier enrollment applications section of the First Coast Service Options Inc. (First Coast) provider website. This page provides an overview of provider-supplier enrollment, as well as links to enrollment applications.
Q: I submitted an application to change my address. What should I do to check the status of my enrollment application?
A: Providers may check the status of their enrollment applications through First Coast Service Options’ (First Coast’s) online lookup or through First Coast’s interactive voice response (IVR) system:
• Enrollment status lookup -- use this application to check the status of your enrollment in the Medicare program. You may search for pending applications by entering your national provider identifier (NPI) and provider transaction access number (PTAN) or check the status of a specific application by entering the 12-digit correspondence control number (CCN) and three-digit record number (listed in your acknowledgement letter).
• IVR system:
• Part A: Call 1-877-602-8816 and select option-7
• Part B: Call 1-877-847-4992 and select option-7
Q: What is the provider’s legal business name that should appear on CMS-855 Medicare enrollment applications?
A: A provider’s legal business name is the name that is registered with the Internal Revenue Service (IRS) and should appear on IRS documents, such as the CP-575, that contains a provider’s employee identification number (EIN) or tax identification number (TIN).
The provider’s legal business name with the IRS should identically match (including any or no punctuation) the business name registered with the National Plan & Provider Enumeration System (NPPES), which issues the national provider identifier (NPI). This is the information that will be loaded into the Provider Enrollment, Chain and Ownership System (PECOS). PECOS and NPPES must match exactly.
To validate that the legal business name the IRS has for you matches the business name registered with NPPES by visiting the NPPES website external link or contacting them at 1-800-465-3203 or 1-800-692-2326 for TTY services.
Q: What are the differences in completing Section 4 of a CMS-855I application for a sole proprietor versus a sole owner?
A: Sole Proprietorship - Section 4F of the CMS-855I is completed with the employer identification number (EIN). The instructions in this section state, “if you are a sole proprietor and you want Medicare payments to be reported under your EIN, list it below.” Only one national provider identifier (NPI) number is needed for the provider. Sole proprietors do not complete section 4A.
Sole Ownership - Section 4A of the CMS-855I is completed with the tax identification number (TIN). If anything is listed in section 4A, a separate NPI number must be obtained for the group number that will be assigned and listed in section 4A. The individual’s NPI number and information must be listed in section 4C.
CMS recently made available a document that will assist physicians and non-physician practitioners in completing the CMS-855I form titled Medicare Provider Enrollment of Individuals (Physicians and Non-Physician Practitioners) external pdf file. Scenarios 2a, 2b, 3 & 4 are very helpful in determining if you are a sole proprietor or sole owner.
Q: What information should be in Section 4 of the CMS-855R form?
A. The following information is required:
Initial Reassignment
Section 4A on page 6 is signed and dated by the person reassigning their benefits. Section 4B is signed and dated by the group’s authorized official or delegated official. If either signature is missing, First Coast Service Options, Inc. (First Coast) will return the application.
Terminating Reassignments
If the individual terminates a reassignment, the individual signs and dates section 4A.
If the organization terminates a reassignment, the group’s authorized official or delegated official signs and dates Section 4B.
For terminations, both signatures are not required. However, if no signatures are present, First Coast will return the application.
Applicable to all CMS-855R applications
The authorized or delegated official who signs section 4B must be currently on file with First Coast. All signatures must be original, preferably in blue ink. Faxed, stamped, or photocopied signatures cannot be accepted.
If the application is not signed and dated appropriately, the application will be returned. The application will need to be corrected and resubmitted. Any application resubmission must contain a brand new authorization page with proper signatures and dates. The provider cannot simply add its signature to the original authorization it submitted.
Provider enrollment application fee amount for 2016
On December 3, CMS issued a notice: Provider Enrollment Application Fee Amount for Calendar Year 2016 [CMS–6066–N] (http://go.usa.gov/ckj8Z external link). Effective January 1, 2016, the calendar year (CY) 2016 application fee is $554 for institutional providers that are:
• Initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP)
• Revalidating their Medicare, Medicaid, or CHIP enrollment• Adding a new Medicare practice location
This fee is required with any enrollment application submitted from January 1 through December 31, 2016.
References:
[1]: Enrollment Applications | CMS
[2]: Become a Medicare Provider or Supplier | CMS
http://www.cms1500claimbilling.com/p/medicare-provider-enrollment-question.html