How to enroll in Medicare through PECOS

To enroll in Medicare through PECOS, get an NPI and an Identity & Access Management (I&A) account, then file the right application online: the CMS-855I for an individual provider, with reassignment to a group on that same form, and the CMS-855B for a group or clinic, each with EFT details and a bank letter. Sign it electronically, upload your documents and answer any request from your Medicare Administrative Contractor (MAC) within 30 days. File before the first Medicare visit, because your effective date can be no earlier than the day the MAC receives the application, and Medicare pays back only 30 days from there.

Below is the order we file in for a new provider or a new group, and the rules that decide when you can bill. For the full sequence across Medicare, Medicaid and commercial plans, see how to get credentialed with insurance companies.

What you need before you start in PECOS

NPI and NPPES data

Every enrollee needs an active NPI: a Type 1 for each provider and a Type 2 for a group. The name, address and taxonomy in NPPES should match what you enter in PECOS. When they do not, the MAC can refer you back to fix NPPES, and its processing clock stops until you do.

I&A access for providers, staff and surrogates

Individual providers log in to PECOS with the same I&A user ID and password they use for NPPES. A group must name an Authorized Official (AO) in the I&A System: someone who can legally bind the company, such as the CEO, CFO, a general partner, the board chair or a direct owner, as CMS sets out in its provider enrollment guide. The AO can delegate to Access Managers, who can also manage staff and connections.

Everyone else gets in through a connection. An office manager or credentialing specialist joins as a Staff End User, and a billing or credentialing company joins as a Surrogate once the provider, or the group’s AO, approves its connection request, as the I&A Quick Reference Guide walks through.

Both can enter, view and change data. Neither can sign an application, represent the practice, manage staff or approve connections. Only the AO can sign a group’s initial application; an Access Manager can sign later changes and revalidations.

Documents and data

The PECOS checklist for individual practitioners lists what you will enter or upload:

• Legal name exactly as Social Security has it, date of birth and SSN
• School and graduation year, license number with its original and renewal dates, any certification, specialty and DEA number
• Practice location, special payment address and where medical records are stored
• Any final adverse action: a license suspension, a Medicare revocation, a felony in the last 10 years, or an exclusion
• A voided check or bank letter for EFT that shows the legal name, account number and routing number

A group adds its legal business name as the IRS has it, its EIN and business structure, every owner with 5 percent or more, and its managing employees.

Which CMS-855 form you need

The old CMS-855R reassignment form is discontinued. Under the Program Integrity Manual, a provider reassigns benefits in Section 4F of the CMS-855I, and the group’s authorized or delegated official signs for the group. One 855I can add, change or end several reassignments.

The CMS-855O is for physicians and eligible practitioners who order or certify labs, imaging, equipment or home health but never bill Medicare. They need an individual NPI and an eligible specialty, and organizational NPIs cannot order. A provider already enrolled to bill does not file an 855O, and an 855O filer sends no CMS-460, CMS-588 or fee.

If you are the sole owner of a PC, PA or LLC and bill through it, the manual lets the company’s details go on your own CMS-855I; a company with any other owner files its own 855B. Changes to an SSN, a TIN or a business structure cannot be made in PECOS; they go on paper.

How to enroll in Medicare through PECOS, step by step

1. Check NPPES. Confirm each NPI is active and its data matches the license and practice location.
2. Set up I&A. Each provider registers. For a group, the AO registers and is approved, then approves connections for staff or a surrogate.
3. Enroll the group first. The MAC must enroll the group before it approves any reassignment to it, so the group’s CMS-855B goes in before, or with, the providers’ applications.
4. Start a new application. Log in, create a new application, confirm the enrollment scenario PECOS proposes and complete each topic it lists.
5. Add EFT and documents. Complete the EFT section and upload the bank letter with every document PECOS lists at the end.
6. Collect every signature. The provider e-signs their own 855I; the AO signs the group’s 855B, and the group’s authorized or delegated official signs each reassignment. The MAC will not fully process an application missing a signature, fee or document.
7. Submit and track. PECOS emails a tracking ID to each contact person. Check status under View Enrollments or on the public Application Status page.
8. Answer requests. Reply to any MAC request within 30 days, and warn your front desk that a site inspector may arrive unannounced.
9. Read the approval letter. It gives your Medicare number and effective date, and starts the 90 days you have to decide on participation.

Screening levels, site visits and the application fee

The MAC screens every initial application at one of three levels set in 42 CFR 424.518:

Nurse practitioners, occupational therapists, speech-language pathologists and audiologists are all limited risk; more in nurse practitioner credentialing. Physical therapists are the exception: a PT enrolling individually or as a group is moderate risk, so the MAC orders a site visit and cannot approve until it is done. Per the manual, each PT location gets its own visit, an enrolled private-practice PT who is only reassigning gets none, and a physician practice that employs a PT stays limited risk, though the PT does not. More in physical therapy credentialing.

CMS moves any applicant to high risk after events such as an exclusion, or a payment suspension or final adverse action in the past 10 years. And any provider can get a site visit: CMS’s contractors make unannounced visits to Part A and B providers, and a visit the inspector cannot complete can lead to a denial.

The application fee

Physicians, non-physician practitioners and their groups pay no application fee. Institutional providers do: everyone on the CMS-855A or the DMEPOS form, and 855B suppliers other than physician and practitioner groups, such as labs and imaging centers. The fee is $750 for 2026, due with an initial enrollment, a revalidation or a new practice location. You can request a hardship exception in writing; if the fee is missing, the MAC gives you 30 days to pay.

How long PECOS enrollment takes and why it stalls

Section 10.5 of the Program Integrity Manual sets the MAC’s targets for web applications, in calendar days:

• Nothing more needed: 95 percent within 15 days, all within 50.
• Needs a development request, site visit or fingerprints: 95 percent within 50 days, all within 85.

The clock stops while the MAC waits on NPPES corrections, a state licensing board, a question to CMS or fingerprint results. We plan on 30 to 90 days; the payer-by-payer view is in how long credentialing takes.

Most stalls trace back to one of these:

• A development request left unanswered. The MAC needs to ask only once, and your 30 calendar days start the day it sends the request. Miss them and the application can be rejected. A rejection has no appeal, and you must file a new application, which means a new filing date and a later effective date.
• Drafts that expire. PECOS deletes an application left untouched in New or Edit status for 120 days, and rejects one returned for corrections that is not fixed within 30 days.
• Data that does not match. A name, SSN or date of birth that differs from Social Security’s records, or an NPPES record that disagrees with the application.
• A failed site visit. No one there to let the inspector in.

Medicare effective dates and retroactive billing

Under 42 CFR 424.520(d), the effective date for physicians, non-physician practitioners, their groups, and physical, occupational and speech therapists is the later of two dates: the day you filed an application that was later approved, or the day you first furnished services at the new location. The filing date is the day the MAC receives the application, on paper or through PECOS. A fast approval does not move it earlier.

42 CFR 424.521 then lets those providers bill for services up to 30 days before the effective date, if circumstances kept them from enrolling sooner, all requirements including state licensure were met, and the services were furnished at the enrolled location. A presidentially declared disaster stretches that to 90 days.

The manual’s own example shows the cost. A physician starts seeing patients on March 1, the application is filed May 1 and approved June 1. The effective date is May 1, the physician can bill back to April 1, and the March visits are never paid. A reassignment to a group follows the same rule. Put in your own start and filing dates to see how many weeks of visits fall in the gap.

In short: file before the first Medicare visit. Medicare pays back 30 days from your effective date at most, and every visit before that is lost.

After approval: participation, changes and revalidation

Participating or non-participating

You have 90 days after the approval letter to decide, by filing the CMS-460 with your initial enrollment; after that, you can change only during open enrollment, generally mid-November to December 31. Participating providers accept assignment on every claim, take the Medicare-allowed amount as payment in full and are paid 5 percent more than non-participating providers. Non-participating providers can accept assignment claim by claim, but on unassigned claims cannot charge more than the limiting charge, 115 percent of the non-participating fee schedule amount.

Report changes on time

42 CFR 424.516(d) gives physicians, non-physician practitioners and their groups 30 days to report a change of ownership, any adverse legal action, or a practice location added, changed or closed. Everything else is due within 90 days. CMS treats a new authorized official, delegated official or managing employee as a change of control, so that is a 30-day item too.

Revalidate every five years

42 CFR 424.515 requires you to resubmit and recertify your enrollment every five years, and CMS can call an off-cycle revalidation. Your MAC sends a notice 90 to 120 days before the due date shown on the Medicare Revalidation List. File late and the MAC can stay your enrollment, which holds payments, or deactivate your billing privileges. Physical therapists get a new site visit each time.

How ReliableCare handles Medicare enrollment

We check NPPES first, then set up PECOS access with your AO through a staff or surrogate connection you approve, so your providers and AO only have to sign. We file the group’s 855B and each provider’s 855I with reassignment and EFT in the right order, answer MAC requests the day they arrive, and get PT clinics ready for the site visit. Then we confirm the effective date in writing, file the CMS-460 if you choose to participate, and put revalidation and reporting deadlines on a calendar we watch.

Credentialing is $189 per payer application. When you enroll with more payers, the price per payer drops: $150 per payer for up to 7 payers, and $120 per payer for up to 20 payers. No setup fees. See provider enrollment and credentialing for what each application includes, and pair it with medical billing so claims held for a pending provider go out the week the effective date lands.