The Centers for Medicare and Medicaid Services (CMS) is committed to ensuring
that the Provider Enrollment, Chain, and Ownership System (PECOS) application
is accessible to the widest possible audience, regardless of technology or ability.
PECOS strives to comply with technical standards §1194.21, §1194.22, §1194.31
and §1194.41 of the United States' Federal Section 508 accessibility legislation.
These standards are intended to make web content and applications more accessible
for people with disabilities. Moreover, conformance with these standards helps make
the web more user friendly for all people.
If you should have any accessibility questions, suggestions or experience difficulty
using PECOS, please contact the PECOS team via email at PECOS@cgifederal.com.
The PECOS application was developed and tested to work with Internet Explorer (IE)
Version 8 and 9. In addition, the PECOS application also supports the latest stable versions
of Google Chrome and Mozilla Firefox browsers.
the PECOS application to work properly. Refer to the following directions to enable
An Internet Explorer/Chrome/Firefox user can easily change the accessibility options in their browser.
Use the following links to learn more about the options Internet Explorer/Chrome/Firefox includes to
make things easier to see on the computer screen, or to adjust to your visual
For example, changing the way a web page looks can help users with vision impairments.
All visual browsers should offer a means to increase or decrease the size of text on
a web page. The PECOS application uses mostly relative font sizes, compatible with
the user-specified "text size" option in visual browsers. The following table provides
the IE keyboard keystrokes, menu commands, and shortcuts available to adjust text size.
Table 1: Methods to Resize Text in Internet Explorer
The PECOS application's interface is designed to promote usability and
support compliance with assistive technology. The following sections outline
some specific design elements used throughout the PECOS application.
All primary pages in the PECOS application have a consistent structure as
follows (reading from top to bottom):
The "skip to main content" link provides a convenient shortcut to the main content
of the page. This shortcut saves a keyboard user from having to tab through the
global navigation links before they get to the core information (content) on the
page. It also enables screen reader users to jump their screen reader to the start
of the content and saves them from having to listen to the global navigation area
on each page. The "skip to main content" link is hidden as the first link on the
top of every PECOS page. When focus is concentrated on the link, the "skip to
main content" link text is visible above the PECOS logo. Once the user navigates
away from the link, the link text once again becomes hidden. Clicking on the "skip
to main content" link brings the user to the beginning of the PECOS breadcrumbs on
The global navigation area provides access to the PECOS Home page, Help interface
and Logoff page from any page within the PECOS application. The global navigation
area also includes a breadcrumb trail, which is a list of horizontal hyperlinks at
the top of most pages (i.e. Home > My Enrollments > Application Questionnaire).
These breadcrumbs provide the user with a quick location reference and illustrate
the path they have taken through the system. Each segment of the breadcrumb is added
or updated as the user continues on a navigation path. Clicking on the hyperlinked
breadcrumbs navigates the user back to that PECOS application page.
Every PECOS page has a heading at the start of the main content of the page. This
heading is always the first heading on the page.
The main content area is included within a blue-bordered frame on every PECOS page.
The heading for the main content area is included as white text with a blue background
within the frame.
Like the global navigation area, the global footer area provides access to the PECOS Home
page, Help interface, and Logoff page from any page within the PECOS application.
The global footer area also includes links to other Department of Health and Human
Services (HHS) and CMS websites.
The PECOS Identity and Access Management (I&A) interface provides user authentication
services for the PECOS application. The page structure in PECOS I&A differs from
the page structure in the rest of the PECOS application.
All PECOS I&A pages have a consistent structure as follows (reading from top to bottom):
The "skip to main content" link in PECOS I&A is hidden as the first link on the top of
every page. The link text remains hidden when focus is concentrated on the link (either
via keyboard or mouse). Clicking on the "skip to main content" link brings the user to
the heading at the start of the main content on the page.
The global navigation area provides access to the PECOS I&A Help interface and Logoff
function from any page within PECOS I&A. The global navigation area also includes an
Application Sections menu, which displays each of the PECOS I&A pages that the user
must complete to create a PECOS login application. The current page in the path is
highlighted in yellow text and the Previous Page and Next Page buttons are used to
navigate between the application sections. The Application Sections menu contains the
following sections: User Profile, Employer Information, and Provider/Supplier Organization.
Every primary PECOS I&A page has a heading at the start of the main content of the page.
This heading is always the first heading on the page.
The main content area is identified by the headings defined on each PECOS I&A page.
CSS is used to control some visual formatting and presentation in both PECOS I&A
and the PECOS application. PECOS pages are not designed to interfere with
user-defined style sheets. Moreover, if your browser or browsing device does
not support style sheets at all, the content of most pages is still readable
and understandable. Note: There are certain pages in PECOS that do not display
content correctly when CSS is disabled. Please refer to the Accessibility
Exceptions section for more information.
On some pages, text links will trigger a new browser window to open. Text links
that open a new browser window are denoted as follows:
The PECOS application uses "layout tables" to control the visual layout of the pages.
As a result of the table-based layouts, screen reader users have to listen to the screen
reader detect this information. However, screen reader users can distinguish between the
presence of actual data tables used for presenting and tabulating data versus layout tables.
For actual data tables, table headers are used to help screen readers make sense of table
structures. For layout tables, neither a summary description nor table headers are provided.
Users may download populated CMS 855 Medicare forms, supporting documentation, and other
PECOS documents as an Adobe Acrobat PDF. PECOS includes the following note on each
page that a PDF can be generated:
For security purposes, the PECOS application times out after thirty minutes of inactivity.
Once the session has been inactive for twenty-five minutes, a dialog box displays to notify
the user that they are about to be timed out. The dialog box explains that the user will lose
any unsaved data if they do not continue working in the PECOS application before their
session expires. Once the session inactivity has reached the thirty-minute mark, then the user
is logged out of PECOS and any unsaved data is lost.
The PECOS application does not use access keys.
Every PECOS page should be fully accessible with a keyboard; a mouse should not be required.
In other words, a user can use the keyboard to navigate through pages in the PECOS application
by selecting links, completing form controls, and using form buttons.
The following table provides a summary of useful IE keystrokes used to navigate pages and
complete forms in the PECOS application.
Table 2: Useful IE Keystrokes
Microsoft Windows provides a range of accessibility options that can be turned on
from the keyboard. The following table provides a summary of some common
Windows XP accessibility options
a user can choose to make their keyboard easier to use.
Table 3: Common Windows Keyboard Accessibility Options
This section provides some basic guidance for screen reader users based on our testing
with JAWS 9.0. We recognize that not all screen reader users use JAWS and not all JAWS
users are using the same version, but the advice and principles should be applicable to
other screen readers and most versions of JAWS.
In order to benefit from all the accessibility features available in the PECOS
application, it is recommended that JAWS screen reader users use the following
HTML configuration options while working in the PECOS application. To set these
The following keystrokes all find the next occurrence of a particular element on a page.
Using the Shift key at the same time will find the previous occurrence.
Table 4: Useful JAWS Keystrokes
To use the forms in the PECOS application:
In general, mandatory fields are indicated by an asterisk (*) at the end of the field label.
Each PECOS page containing mandatory fields has an indicator in the main content area stating
that "(*) Red asterisk indicates a required field."
Users using recent versions of the JAWS screen reader can navigate using headings via the
Although a screen reader user can listen to the contents of tables cell by cell by pressing the
down arrow, JAWS gives the user the ability to move their cursor around the table so they can
read the data table in much the same way as a sighted person. The keystrokes for doing this are
in the following table.
Table 5: JAWS Table Reading Keystrokes
JAWS provides the very useful "navigation lists" to list the page's form fields, headings and
links in dialog boxes. Not only does this give you a convenient summary of these elements but
you also have the option of acting on them. The keys used to display the dialogs and the actions
you can perform are as follows:
Table 6: JAWS Navigation Lists
Alternatively, you can use Insert + F3 to open the JAWS Virtual HTML Features dialog and
select from the full set of JAWS navigation lists.
While the PECOS application strives to adhere to the Federal Section 508 guidelines and
standards for accessibility, it is not always possible to do so in all areas of the application.
This section provides information on the aspects of the PECOS and PECOS I&A applications
that are currently inaccessible.
If you should have any accessibility questions, suggestions or experience difficulty using PECOS,
please contact the PECOS team via email at PECOS@cgifederal.com.
In addition, if you find that PECOS is inaccessible to your needs, you may submit a
paper CMS-855 Medicare Enrollment Application
as an alternative.
The PECOS application generates all documents as an Adobe Acrobat PDF. Currently there are
known defects with the PDF reading order that make it difficult for the PDFs to be read by
a screen reader. For example, a screen reader such as JAWS will read the page headers and
footers on every page of a PECOS PDF before reading the main content of the page. This
means that a screen reader user listening to a forty page PDF will hear the header and
footer forty times before listening to the main content of the page. In addition, on some
pages of the PECOS PDFs, the main content of the page is read out of order. For example,
on some pages a screen reader will skip the section title for the page and instead read the
first paragraph of the main content. Once the first paragraph is read, the screen reader
will then read the section title that it previously skipped and continue reading the remainder
of the main content of the page.
CSS is used to control the content that is displayed on certain PECOS pages. When CSS is
disabled on these pages, the presentation of the content may become confusing to users.
For example, some PECOS pages feature a question with Yes/No options (e.g., "Does the
applicant have any billing agencies for this application?"). The content that is displayed
on the page is controlled by CSS and changes according to the response the user provides
to the question. When CSS is disabled, all of the messages that could appear are displayed
to the user and it is unclear which message actually applies.
PECOS I&A uses yellow font color to convey meaning. The PECOS I&A section navigation sidebar
highlights in yellow font the step the user is currently on in the application process. The
yellow font on the white background provides poor color contrast and may be difficult for
visually-impaired users to distinguish.
The skip navigation method ("Skip to Main Content" link) in PECOS I&A is affected by a known
defect in the Microsoft IE version 6 browser. This defect occurs when a user utilizing the
JAWS screen reader navigates to the PECOS I&A Login Form page (or any other page beyond the
PECOS I&A login form). The input focus does not work correctly for in-page links using IE
with the keyboard. In addition, when the user tabs to the "Skip to Main Content" link, presses
the Enter key, and then tabs again, they are navigated back to the "Skip to Main Content" link
instead of being navigated to the first active element in the "main content".
For security purposes, PECOS I&A is required to time out after a predetermined period of
inactivity. PECOS I&A does not currently alert users to give them an option to request more
time to complete the operation. As a result, the user is not notified before the system times
out and any information displayed on the screen (and not yet saved) is lost.