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About Internet-based PECOS Internet-based PECOS supports the Medicare provider and supplier enrollment process by capturing provider/supplier information found on the CMS-855 family of forms. Through this system, members of the Medicare provider and supplier communities can perform most enrollment activities online, including:

Initially enrolling in the Medicare program
Changing existing Medicare enrollment record information
Reassigning Medicare benefits and terminating existing reassignments
Reactivating existing Medicare enrollment records
Deactivating existing Medicare enrollment record

There are two objectives of Internet-based PECOS: One is to make it easier for providers and suppliers to enroll in the Medicare program by simplifying the enrollment process into small and easy-to-understand pieces. The second is to shorten the enrollment timeframe by having the system verify provider information online and then electronically transmit the enrollment data directly to the Medicare fee-for-service contractor or Medicare Administrative Contractor (MAC) responsible for processing it.

Internet-based PECOS guides the user through multiple validation processes to assist in submitting a complete and accurate Medicare enrollment application. The first process assists the user in determining the type of application to submit (e.g., an initial enrollment vs. a change of information). While completing the application, the system provides guidance and messages as to what information is required for the application type and if any entered information is invalid. Finally, during the submission process, the system validates and confirms information and allows the user to electronically submit an application for processing and approval by the identified Medicare fee-for-service contractor or MAC. The submission process also allows the user to print required materials, and instructs the user as to what materials must be signed and/or sent to the Medicare fee-for-service contractor or MAC.

Enrollment Steps Overview

The following steps present the high-level Medicare enrollment process:

Individual Practitioners should register for an account with the National Plan and Provider Enumeration System NPPES. Organization users should register for an account via the PECOS Identity and Access Management (I&A) system
Complete, review, and submit a Medicare enrollment application online
Print, sign, and mail required certification statements and supporting materials as requested
A CMS contracted Medicare fee-for-service contractor or Medicare Administrative Contractor (MAC) will process the materials to determine the provider/supplier enrollment status

Once an electronic application and all paperwork are received, the Medicare fee-for-service contractor or MAC starts the approval process. The Medicare application is first reviewed for completeness and accuracy. If a correction or more information is needed, the Medicare fee-for-service contractor or MAC notifies the applicant/user via E-mail and checks in the application. The applicant/user then has the opportunity to make the correction and resubmit. Next, the Medicare contractor creates the enrollment record by accepting the submitted application data. Once this is done, the Medicare contractor changes the status of the application to Approved. This status is reflected on the My Enrollments page in Internet-based PECOS.

Advantages to Using Internet-based PECOS

Simplifies user interaction via specialized Scenarios that:

Are modeled on specific submittal reason(s) shown on the CMS-855 family of forms
Request only the information relevant to the application reason
Display existing Provider Enrollment, Chain, and Ownership System (PECOS) data to facilitate application entry and enhance the user experience

Reduces enrollment errors by:

Helping users select the correct Scenario through a series of profiling questions
Providing online data edits