Medicare application essentials
PECOS is Medicare’s online enrollment system. Before you begin, confirm which application your practice needs, gather the supporting documents and make sure the right people can access and sign the record.
Improve the processing of your application by making it complete and accurate before submitting. Sending information you know is incomplete or incorrect can create more follow-up work and delay approval.
Check your legal business name and tax identification number against your IRS records, such as a CP 575 or 147C letter. Review your NPI record, business details and banking documentation for inconsistencies before applying. Resolve differences rather than assuming they will be corrected during processing.
Back to contents ↑Frequently asked questions
Do I need malpractice insurance to apply?
For a standard individual CMS-855I enrollment, malpractice coverage is not listed as a general application requirement. That does not remove any insurance obligation imposed by your state, employer, facility or other payer. Check those requirements separately.
Are hospital privileges required?
Hospital privileges are not a general requirement of the individual CMS-855I application. Requirements for admitting arrangements, facility privileges and commercial payer participation depend on your practice and the services you provide.
How long does it take?
Timing depends on the enrollment type, the contractor and whether the application is complete. Missing documents, signatures or follow-up information can delay a decision. Use PECOS to check your application status and ask your Medicare Administrative Contractor (MAC) about its current processing times.
Can I retroactively bill?
Not automatically. Payment depends on the approved effective date, any permitted retrospective billing period and the other claim requirements. Do not assume every service provided while an application is pending will be payable. Read our guide to retrospective Medicare billing before planning around those claims.
Do I need general liability insurance?
Requirements differ by supplier type. DMEPOS suppliers must maintain comprehensive liability coverage of at least $300,000 per incident and provide the required insurance evidence. Malpractice coverage does not satisfy this DMEPOS requirement. Review CMS-855S, section 7 for the details that apply to your application.
Will my Medicare enrollment transfer to another state?
Do not assume an existing record covers a new practice location. Depending on the location and MAC jurisdiction, you may need to update an enrollment or submit a new one. Ordering-and-certifying-only enrollment has different rules. Confirm the correct action with your MAC before billing from the new location.
Do I need a Type 2 NPI to apply?
An individual uses a Type 1 NPI. A provider organization generally uses a Type 2 NPI; a sole proprietor does not obtain a separate Type 2 simply because the business has an EIN. If you are joining an existing group, the group supplies its organization information. See our NPI registration guide and choose the enrollment scenario that matches your legal structure.
01 / Account access
Set up Identity & Access Management
Start by checking the NPI Registry if you are unsure whether you already have an NPI. Many providers already have one from training or previous employment.
Your Identity & Access Management (I&A) account provides access to NPPES and PECOS. Create an account or recover your existing access, then complete the required authentication. If you need an NPI, apply through NPPES before submitting your Medicare enrollment.
For organizations, confirm the authorized official and staff connections in I&A. Each person should use their own account with the appropriate access. Our account access guidance can help you find the right recovery steps.
Back to contents ↑02 / Your enrollment record
Log in to PECOS
Use your I&A credentials to log in to PECOS. Review existing enrollments before starting a new application, and select the scenario that matches your role and business structure.
If you are setting up a new company, confirm its legal structure, registration and tax ID first. The IRS online EIN application is the official starting point for obtaining an employer identification number.
Back to contents ↑03 / Submit and follow through
Complete your application
Your application may involve joining a group, opening your own practice, enrolling a provider organization or reporting ownership and management information. Follow the PECOS questions for your actual circumstances.
- Complete the relevant enrollment topics and upload the required supporting documents.
- Arrange the required signatures and any applicable fee before final submission.
- Keep the submission confirmation and tracking information.
- Check the application status and respond to your contractor’s requests by the stated deadline.
PECOS applications generally process faster than paper applications, but an online submission is not an approval. Review the approval notice and billing effective date before relying on the enrollment.
PECOS video tutorials
For current screens and instructions, start with the tutorials and help links on the PECOS website.
Earlier PPS-linked video walkthroughs
These videos remain available as background. Interface details may differ from the current system.
- Individual Provider : starting sole proprietorship or joining an established group
- Organizational provider: setting up new company that plans to bill Medicare
- Change of Information for individual: Updating current enrollment record with Medicare
- Change of Information for Organization
- Creating a new DMEPOS Supplier Number
What you’ll need for your application
Prepare the information that applies to your provider type and enrollment scenario:
- Practice and mailing addresses, contact details and billing company information, if applicable
- Individual and organization NPIs, as appropriate
- State licenses, certifications and other professional credentials required for your provider type
- DEA information, when applicable
- Legal business name, tax ID, entity information, and ownership and management details
- IRS documentation verifying the business name and tax ID
- A voided check or bank letter for electronic funds transfer, when required
Use the free Medicare bank letter template to help prepare your bank documentation.
Medicare paper application downloads
If you use paper forms, get the current version from CMS enrollment applications and follow the instructions for your provider type.
- CMS-855AInstitutional providers, including hospitals and rural health clinics
- CMS-855BClinics, group practices and certain other suppliers, including independent laboratories
- CMS-855IPhysicians and non-physician practitioners, including reassignment information
- CMS-855OEligible professionals enrolling solely to order or certify, without billing Medicare for their services
- CMS-855SDMEPOS suppliers
Medicare enrollment support
PPS supports individual providers, groups, DMEPOS suppliers, facilities and laboratories with initial enrollment and revalidation. Talk with us about the application and follow-up work your organization needs.
Ask about enrollment assistanceReference: CMS Medicare Provider Enrollment guide. Use the current CMS instructions and your contractor’s guidance for your application.
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