Medicare & Insurance

Medicare enrollment

Medicare provider/supplier enrollment applications: The Medicare enrollment application (CMS-855 or Internet-based Provider Enrollment, Chain and Ownership System (PECOS)) is an Office of Management and Budget approved form and is available in PDF fillable format. This format allows a user to complete an application using Adobe Acrobat and save this information on their personal computer or download the application.

• 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 Practioners
• CMS-855S Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
• CMS-855POH Medicare Enrollment Application for Physician Owned Hospitals

Required re-enrollment or "revalidation"

Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers/suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria.

The most efficient way to submit your revalidation information is by using the Internet-based PECOS location on the CMS website. PECOS allows you to review information currently on file, update and submit your revalidation via the Internet. You must either electronically sign the revalidation application or print, sign, date and mail the paper certification statement to your MAC.

Important: Each provider/supplier is required to revalidate their entire Medicare enrollment record to include all active practice locations and/or current reassignments.

Established due dates - The CMS has established due dates by which you must revalidate. The revalidation due dates will always be on the last day of the month (i.e., June 30, 2016; July 31, 2016; August 30, 2016). You are expected to submit your revalidation application by this date. Generally, this due date will remain with you throughout subsequent revalidation cycles.

Posted due dates on data.cms.gov - Beginning March 1, 2016, a listing of all currently enrolled providers/suppliers will be available at CMS' website. DME supplier information will currently display as blank and will not include due dates at this time. Those due for revalidation will display a revalidation due date, all other providers/suppliers not up for revalidation will display a "TBD" (To Be Determined) in the due date field. The revalidation due date will be posted up to 6 months in advance of the revalidation due date to provide sufficient notice and time for the provider/supplier to comply. The file will be updated periodically.