Enrolling in the Medicare program is necessary to receive payment for covered services provided to Medicare patients. Determine if you’re eligible to enroll and how to complete enrollment.
Providers must enroll in the Medicare Program to receive payment for providing covered services to Medicare patients. Determine if you’re eligible to enroll and how to complete enrollment.
We list the institutional providers on the Medicare Enrollment Application: Institutional Providers (CMS-855A), including:
- Community mental health centers
- Comprehensive outpatient rehabilitation facilities
- Critical access hospitals
- ESRD facilities
- Federally qualified health centers
- Histocompatibility laboratories
- Home health agencies
- Hospices
- Hospitals and hospital units
- Indian Health Service facilities
- Opioid treatment programs
- Organ procurement organizations
- Outpatient physical therapy, occupational therapy, speech-language pathology services
- Religious nonmedical health care institutions
- Rural emergency hospitals
- Rural health clinics (RHCs)
- Skilled nursing facilities (SNFs)
The Medicare Enrollment Application: Physician and Non-Physician Practitioner (CMS-855I) and the Medicare Enrollment Application: Clinic/Group Practice and Certain Other Suppliers (CMS-855B) identify specific physicians, non-physician practitioners (NPPs), clinic or group practices, and suppliers who can enroll as Part B providers.
NPPs include nurse practitioners, clinical nurse specialists, and physician assistants practicing with or without physician supervision.
Some institutional providers may choose voluntary accreditation by a CMS-recognized accreditation organization instead of the State Survey Agency. The accreditation organization will notify the State Survey Agency of its decision.
CMS assigns the CMS Certification Number and effective date, signs the agreement with the provider, and updates the certification database. Your MAC will send their final approval or denial letter.
If approved, you’ll receive a fully executed provider agreement.
The Enrollment & Certification Roadmap for Institutional Providers has more information about points of contact for deemed and non-deemed providers.
To enroll in the Medicare Program, obtain an NPI through:
- The NPPES system
- Paper NPI application form (CMS-10114)
Look up your NPI on the NPPES NPI Registry.
After you receive an NPI, you can:
- Complete Medicare program enrollment
- Reauthenticate your enrollment
- Change your enrollment information
Before you enroll, obtain the necessary enrollment information and complete actions using PECOS or paper enrollment forms.
After we approve your I&A System enrollment, submit your PECOS enrollment application.
PECOS provides a script-driven application, asking questions to retrieve information for your specific enrollment scenario. You can use PECOS to submit all supporting documentation. Follow these instructions:
- Log in to PECOS.
- Continue with an existing enrollment or create a new application.
- Once PECOS identifies your enrollment scenario and you confirm it’s accurate, you’ll see topics for submitting your application. To complete each topic, enter the required information.
- At the end of the data entry process, PECOS:
- Confirms you entered all necessary data
- Lists the documents the MAC needs to submit for review
- Provides an electronic signature and attestation option
- Displays your MAC’s name and mailing address
- Lets you print your application for your records (don’t mail a paper copy to your MAC)
- Submits the electronic application to your MAC
- Sends you an email to confirm your MAC received the application
Submit the appropriate paper application if you can’t use PECOS. Carefully review the paper enrollment instructions to decide which form best suits your practice. The paper application collects your information, including documentation verifying your eligibility for Medicare Program enrollment.
If you submit a paper application, your MAC will process your application and create a Medicare enrollment record by entering the data into PECOS.
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.
The MAC pre-screens and verifies the application’s completeness. If the MAC needs more information, respond to the information request within 30 days. Otherwise, the MAC may deny your enrollment.
Your MAC won’t fully process your PECOS application without your electronic or uploaded signature, application fee (if applicable), and required supporting documentation. The application filing date is the date the MAC receives your application.
You can check your PECOS application status 2 ways:
When your MAC approves your application, it changes the PECOS record to approved status and mails you an approval letter.
Report Medicare enrollment changes using PECOS. Physicians, NPPs, and physician and NPP organizations must report changes in ownership or control (including changes in authorized or delegated official), changes in practice location, and any final adverse legal actions (such as felony convictions or federal or state licensure suspensions) within 30 days of the change and report all other changes within 90 days of the change.
