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Internet Based PECOS Application

To enroll in Medicare, ensure your NPI, User ID, and password for the NPPES system are handy. If you lack this information, call 1-800-465-3203 for assistance. For Internet-based PECOS, visit CMS documentation at the provided link, complete your enrollment, and print the Certificate of Statement to mail to your Medicare Contractor. For paper-based applications, complete the CMS-855 (and CMS-855R if reassigning benefits) with your NPI. Send the signed forms with the necessary documentation to the specified address, and await further instructions regarding your enrollment status.

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Internet Based PECOS Application

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  1. 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. Internet Based PECOS Application Read the documents that are available about Internet-based PECOS at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/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. 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) Paper Based PECOS Application 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)

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