Internet Based PECOS Application

1
Internet Based PECOS Application
Have your NPI available, also have your User ID
Password for the NPPES System. If you do not
have these available you may call 1-800-465-3203.
They will be able to assist you.
Read the documents that are available about
Internet-based PECOS at http//www.cms.gov/Medicar
e/Provider-Enrollment-and-Certification/MedicarePr
oviderSupEnroll/InternetbasedPECOS.html
After you have completed and submitted your
enrollment. Print the Certificate of Statement.
Print, sign date the certificate statement,
mail to the Medicare Contractor (the address
should have been displayed to you) in with any
supporting documentation .
2
Paper Based PECOS Application
Go to CMS forms page www.cms.hhs.gov/cmsforms ,
print and complete the CMS-855I (if you reassign
benefits to a clinic or group practice other than
your own, complete a CMS-855R as well)
You will need your NPI number to fill out the
CMS-855 (and CMS-855R), if you need assistance
with your NPPES Enumerator, User ID and password,
contact the NPI Enumerator at 1-800-465-3203.
Once you have completed the CMS-855 and
(CMS-855R), sign , date and mail (the address
is provided on the form) with any additional
required documentation.
Once your address is received they will begin to
process your enrollment, if any further
information is needed they will contact you.
( if you reassign benefits to a clinic or group
practice other than your own, complete a CMS-855R
as well)