cms national site visit contractor

Medicare Provider Enrollment – Site Verification

by nCred | Medicare Provider Enrollment | 0 comments

Medicare Provider Enrollment News

CMS contracts with a third party to provide site visit services as an integral part of the Medicare Provider Enrollment process. The National Sive Visit Contractor (NSVC) will conduct site visits for all providers and suppliers except for Durable Medical Equipment (DMEPOS) which will continue to be inspected by the National Supplier Clearinghouse. MSM Security Services, LLC has the national site visit contract. MSM, or one of its subcontractors, will conduct a site verification and screening process according to Medicare guidelines to prevent questionable providers and suppliers from enrolling in the Medicare program. When an inspector shows up, he or she will have valid ID and a letter of authorization to begin the inspection. You may not copy or retain the ID or letter of authorization. You may contact MSM at any point if you have questions at 855-220-1074.

The site verification may be as quick as verifying your business location, or an inspector may physically show up to tour your clinic. The process ensures that providers aren’t able to Enroll as participating Medicare providers without an appropriate service location.

You may see full details in section 10.6.20 of the Medicare Program Integrity Manual .

Call nCred today at (423) 443-4525 to discuss your Medicare Provider Enrollment needs. We work with all specialties and have extensive experience processing Medicare applications.

From the Medicare Program Integrity Manual:

10.6.20 – Screening: On-site Inspections and Site Verifications (Rev. 11949; Issued: 04-13-23; Effective: 04-21-23; Implementation: 06-19-23)

The contractor shall review section 10.3 of this chapter for special instructions regarding site visits. In the event of a conflict, those instructions take precedence over those in this section 10.6.20.

A. DMEPOS Suppliers and IDTFs

The scope of site visits of DMEPOS suppliers and IDTFs shall continue to be conducted in accordance with existing CMS instructions and guidance. (For purposes of this section 10.6.20, the term “contractor” refers to the Medicare Administrative Contractor; the term “SVC” refers to the site visit contractor.)

B. Provider and Supplier Types Other Than DMEPOS Suppliers and IDTFs

For provider/supplier types other than DMEPOS suppliers and IDTFs – that must undergo a site visit pursuant to this section 10.6.20 and § 424.518, the SVC will perform such visits consistent with the procedures in this section 10.6.20. This includes all of the following:

(1) Documenting the date and time of the visit, and including the name of the individual attempting the visit.

(2) Photographing the provider/supplier’s business for inclusion in the provider/supplier’s file. All photographs will be date/time stamped.

(3) Fully documenting observations made at the facility, which could include facts such as (a) the facility was vacant and free of all furniture, (b) a notice of eviction or similar documentation is posted at the facility, and (c) the space is now occupied by another company.

(4) Writing a report of the findings regarding each site verification.

(5) Including a signed site visit report stating the facts and verifying the completion of the site verification.

In terms of the extent of the visit, the SVC will determine whether the following criteria are met: (i) the facility is open; (ii) personnel are at the facility; (iii) customers are at the facility (if applicable to that provider or supplier type); and (iv) the facility appears to be operational. This will require the site visitor(s) to enter the provider/supplier’s practice location/site rather than simply conducting an external review. If any of the four elements ((i) through (iv)) listed above are not met, the contractor will, as applicable – and using the procedures outlined in this chapter and in existing CMS instructions – deny the provider’s enrollment application pursuant to § 424.530(a)(5)(i) or (ii) or revoke the provider’s Medicare billing privileges under § 424.535(a)(5)(i) or (ii).

C. Operational Status

When conducting a site verification to determine whether a practice location is operational, the SVC shall make every effort to limit its verification to an external review of the location. If the SVC cannot determine whether the location is operational based on this external review, it shall conduct an unobtrusive site verification by limiting its encounter with provider or supplier personnel or medical patients.

The contractor must review and evaluate the site visit results received from the SVC prior to making a final determination. If it is determined (during the review and evaluation process) that the location is non-operational based on the site visit results but there is reason to proceed with the enrollment, the contractor shall provide the appropriate justification in the comment section of the Validation Checklist in PECOS. (For example, a second site visit determined the location to be operational; the provider only renders services in patient’s homes; etc.).

If the contractor is unsure of how to proceed based on its evaluation of the site visit results, it shall contact its PEOG BFL and copy its contracting officer’s representative (COR).

Site verifications should be done Monday through Friday (excluding holidays) during their posted business hours. If there are no hours posted, the site verification should occur between 9 a.m. and 5 p.m. If, during the first attempt, there are obvious signs that the facility is no longer operational, no second attempt is required. If, on the first attempt, the facility is closed but there are no obvious indications that the facility is non-operational, a second attempt on a different day during the posted hours of operation should be made.

E. Documentation

As indicated previously, when conducting site verifications to determine whether a practice location is operational, the SVC shall:

(i) Document the date and time of the attempted visit and include the name of the individual attempting the visit.

(ii) As appropriate, photograph the provider/supplier’s business for inclusion in the provider/supplier’s file on an as-needed basis. All photographs should be date/time stamped.

(iii) Fully document all observations made at the facility (e.g., the facility was vacant and free of all furniture, a notice of eviction or similar documentation was posted at the facility, the space is now occupied by another company, etc.).

(iv) Write a report of its findings regarding each site verification.

F. Determination

(In the event an instruction in this subsection F is inconsistent with guidance in section 10.6.6, 10.4.7 et seq., or 10.4.8, the latter three sections of instructions shall take precedence.)

If a provider/supplier is determined not to be operational or in compliance with the regulatory requirements for its provider/supplier type, the contractor shall revoke the provider/supplier’s Medicare billing privileges – unless the provider/supplier has submitted a change of information request that notified the contractor of a change in practice location. Within 7 calendar days of CMS or the contractor determining that the provider/supplier is not operational, the contractor shall update PECOS or the applicable claims processing system (if the provider/supplier does not have an enrollment record in PECOS) to revoke Medicare billing privileges and issue a revocation notice to the provider/supplier. The contractor shall afford the provider/supplier applicable appeal rights in the revocation notification letter.

For non-operational status revocations , the contractor shall use either 42 CFR § 424.535(a)(5)(i) or 42 CFR § 424.535(a)(5)(ii) as the legal basis for revocation. Consistent with 42 CFR § 424.535(g), the date of revocation is the date on which CMS or the contractor determines that the provider/supplier is no longer operational. The contractor shall establish a 2-year reenrollment bar for providers/suppliers that are not operational.

For regulatory non-compliance revocations , the contractor shall use 42 CFR § 424.535(a)(1) as the legal basis for revocation. Consistent with 42 CFR § 424.535(g), the date of revocation is the date on which CMS or the contractor determines that the provider/supplier is no longer in compliance with regulatory provisions for its provider/supplier type. The contractor shall establish a 2-year enrollment bar for providers/suppliers that are not in compliance with provisions for their provider/supplier type.

G. Multiple Site Visits

Notwithstanding any other instruction to the contrary in this chapter, the contractor shall not order a site visit if the specific location to be visited has already undergone a successful site visit within the last 12 months and the applicable provider/supplier is in an approved status.

Consider the following illustrations:

Example 1 – A single-site home health agency (HHA) undergoes a revalidation site visit on February 1. The HHA submits a change of information request on July 1 to add a branch location. The contractor shall order this site visit because the visit will occur at a location (i.e., the branch location) different from the main location (i.e., the location that underwent the February 1 revalidation visit).

Example 2 – A DMEPOS supplier undergoes a revalidation site visit on April 1. It submits an initial Form CMS-855S application on May 1 to enroll a second location. The new location shall undergo a site visit because: (1) it is different from the first (revalidated) location; and (2) it is/will be separately enrolled from the first location.

Example 3 – A physical therapy (PT) group has three locations – X, Y, and Z. As part of a revalidation, the contractor elects to order a site visit of Location Y rather than X or Z. The visit was performed on June 1. On October 4, the group submits a Form CMS-855B to report a change of ownership, thus requiring a site visit under this chapter. However, the contractor shall not order a visit for Location Y because this site has been visited within the past 12 months. Location X or Location Z must instead be visited.

Example 4 – An IDTF undergoes an initial enrollment site visit on July 1. On September 24, it submits a Form CMS-855B application to change its practice location; this mandates a site visit under this chapter. The site visit shall be performed even though the initial visit took place within the past 12 months. This is because the second visit will be of the new location, whereas the first visit was of the old location.

H. Certified Providers/Suppliers – Address Validation Error

Notwithstanding any other instruction to the contrary in this chapter, the contractor need not order a site visit for a certified provider/supplier prior to making a recommendation to the state if an address validation error is received in PECOS. The contractor shall override the error message and notate in the referral package that the address was unverifiable. This avoids multiple site visits being performed (that is, pre-enrollment, survey, and post enrollment).

Credentialing Resources

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CMS awards extension to National Site Visit Contractor

Notice ID: GS-15F-0059MHHSM-500-2012-00009G

Contract: GS-15F-0059M

The Centers for Medicare & Medicaid Services (CMS) implemented certain provisions of the Affordable Care Act to establish additional screening requirements for providers/suppliers.

The CMS Rule 6028-FC published February 2, 2011 (http://federalregister.gov/a/2011-1686) which is now implemented in 42 CFR 424.510, 424.517, 424.530 and 424.535 improves screening mechanisms to prevent questionable providers/suppliers from enrolling in the Medicare program, and requires scheduled, unscheduled or unannounced site visits to providers/suppliers. In addition to fulfilling regulatory requirements, the site verification initiative will also continue to address and support other collaborative efforts with the Office of Inspector General (OIG) and other CMS program integrity initiatives.

The site visit verification process is a screening mechanism to prevent questionable providers/suppliers from enrolling in Part A and Part B of the Medicare program. The initiative described in the SOW builds upon existing site visit programs to create a more efficient, effective, national program to respond to the provisions of the Affordable Care Act, as well as meeting the site-visit requirements described in CMS Publication 100-08, chapter 10 and 15, pertaining to independent diagnostic testing facilities (IDTFs).

Securitas (formerly MSM Security Services, LLC) has been performing as the National Site Visit Contractor (NSVC) for Medicare Parts A and B for 8 years. Previous Limited Source Justifications (LSJs) were executed to maintain continuity while a procurement for multiple award indefinite delivery, indefinite quantity (MA-IDIQ) contracts for Provider Enrollment and Oversight (PEO) services, including two initial task orders for site visit services, was underway. Award of the MA-IDIQ contracts and two task orders for site visit services were completed in August 2020, however, in response to the award, multiple protests were filed with the Government Accountability Office (GAO), necessitating that CMS issue stop work orders for the site verification services task orders. Because on-site visits are required for not only the entire continental United States (U.S.), but also Alaska, Hawaii, and any territories owned by the U.S, Securitas is the only company that is in a position to maintain continuity of site visit services at a reasonable price. Therefore, to maintain continuity of services it is necessary to extend the current task order until the protests are resolved and the work can be transitioned to the new task orders.

Market research was conducted as part of acquisition planning for the PEO MA-IDIQ Contract, which is the vehicle that the new task orders for Site Verification Services (SVS) task orders were awarded under, through a full and open competitive procurement. The current NSVC task order, held by Securitas, was anticipated to run concurrent with the newly awarded task orders to facilitate a transition period. However, a stop work order was issued for the task orders making it necessary for CMS to extend the current GSA task order held by Securitas until the protests can be resolved. Securitas has been providing the services for over eight years and has a record of satisfactory performance as documented via the Contractor Performance Assessment Reporting System (CPARS).

Extension of the current task order is the most suitable and efficient method for maintaining continuity of services. The optional period (January 5, 2021 – May 4, 2021) is included in an attempt to minimize the impact of any delays in resolving the current protests and/or receiving additional protests.

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CMS Site Visits: DME Providers and Suppliers Enrollment Screening
Durable Medical Equipment Billing
June 6, 2018
Martin Jacob

The CMS site visit verification process is a screening mechanism to prevent questionable providers and suppliers from enrolling in Medicare. Providers and suppliers will be screened by the Centers of Medicare & Medicaid Services (CMS) designated national site visit contractor, with the exception of Durable Medical Equipment suppliers which are handled by the National Supplier Clearinghouse .

CMS is strengthening strategies designed to reinforce provider screening activities by increasing site visits to Medicare-enrolled providers and suppliers, enhancing and improving information technology (IT) systems, and implementing continuous data monitoring practices to help make sure practice location data is accurate and in compliance with enrollment requirements.

One important step in Medicare provider enrollment is a site visit.

CMS Site Visits

CMS has the authority to perform site visits on all providers. The site visits verify practice location information to determine compliance with enrollment requirements, and are required for moderate to high-risk providers during initial enrollment, revalidation and when a new location is added. Note that these verification visits are separate from any site visits required at the state level.

The visit is an external and/or internal review by an inspector, with limited disruption to your business. The inspector will introduce himself with a photo ID and a letter of authorization issued and signed by CMS and will:

Take photos of the business.
Observe that the business is in operation at that location.
Verify that the facility is open and operational with both business personnel and customers present.

National Supplier Clearinghouse Site Visits for Durable Medical Equipment Suppliers

DME supplier enrollment site visits are required for initial enrollments and for revalidations.

The inspector will have photo ID, a letter stating the reason for the visit from the inspection manager and a site visit acknowledgement form.

During the visit, the inspector will take photos of your business and conduct an internal review to verify:

Hours of operation
Licenses and certifications
Patient records
Proof of business records such as rental agreements

Staff interviews may be conducted as well.

It’s important to give site inspectors your full cooperation and to answer their questions fully. Failure to do so, or to meet any verification requirements, may result in denial of your enrollment application and/or revocation of your Medicare billing privileges.

If you require medical credentialing and payer enrollment needs for your practice or medical facility, Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly.

CMS Provides Information on SNF Provider Enrollment Site Visit Contractors

East: Palmetto GBA and its subcontractors:
Overland Solutions, Inc., an affiliate of EXL
Information Discovery Services
Compliance Review, Inc.
National Creditors Connection, Inc.
West: Deloitte Consulting, LLP and its subcontractors:
Nationwide Management Services, Inc.
CSI Companies, Inc.
Arthur Lawrence Management, LLC
Computer Evidence Spe cialists, LLC 
Medicare Provider Enrollment : Click on the Enrollment tab and scroll to Step 3.
Medicare Fee-for-Service Provider Enrollment Contact List (PDF) : Contact your Medicare Administrative Contractor to verify that the site visit is valid.

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4 Common Mistakes Not to Make During CMS Medicare Verification Site Visits

Practices and businesses who wish to be enrolled as Medicare providers or suppliers must submit to a site visit as part of the provider enrollment or verification process . The Centers of Medicare & Medicaid Services (CMS) use the information obtained during a site visit to verify that your business is legitimate, and that the information submitted to CMS systems for Medicare enrollment is accurate.

An onsite CMS visit is nothing to be concerned about if your legal health care business is fully compliant with Medicare requirements. Although you still want to dot your i’s and cross your t’s by ensuring your ability to provide services to Medicare beneficiaries are secure.

Below are four common errors to avoid:

Having incorrect information on file for each of your practice locations. Accurate and complete information regarding your location(s) must be on file with your Medicare enrollment contractor. If the CMS auditor can’t find your business that’s a problem.

Failing to make updates regarding changes to your practice. If your address or telephone number changes or you modify the hours of operation, you must inform your Medicare enrollment contractor.

Lack of adequate signage for your practice. CMS site visits take place during posted hours or on Monday through Friday between 9:00 a.m. and 5:00 p.m. If the auditor arrives during the hours shown on your sign and no one is there he can record your business as not operational. The same is true if the auditor is unable to locate your business because the sign is not in plain view or doesn’t clearly show the name of your practice.

Refusing to cooperate with a CMS auditor. Verification and reverification requests may entail the auditor taking photos, interviewing staff and asking questions. Medicare providers and suppliers who don’t fully comply with auditor requests or fail to meet any verification requirements may have their enrollment application denied and/or have Medicare billing privileges revoked.

Let Us Manage All Your Payer Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson , our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website .

Categories: Credentialing Requirement , Knowledge Center

Tags: CMS , medical credentialing , medicare providers , payer enrollment , provider enrollment , verification process

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Nursing Facility Medicare Provider Enrollment Verification Site Visits

Nursing facility providers may receive site visits from the National Site Visit Contractor (NSVC) on behalf of the Centers for Medicare and Medicaid Services (CMS). The NSVC may take pictures of the building to verify practice location and structure to determine compliance with Medicare enrollment and other requirements ( 42 CFR §424.518 ). You can contact your Medicare Administrative Contractor (MAC) to verify the site visit.

The Calendar Year 2023 Medicare Physician Fee Schedule Final Rule contains information about requirements for Medicare provider enrollment, including §424.518, which describes the requirements for Medicare contractors to screen all initial, revalidation, change of ownership applications, and applications to report a new owner. There are three levels for screening: “limited,” “moderate,” or “high.” Providers categorized in the “moderate” or “high” risk category must undergo a site visit.

Read CMS Pub 100-08 Medicare Program Integrity Transmittal R11808PI describing this change and Section J, Medicare Provider and Supplier Enrollment in the Federal Register .

Read Medicare Learning Network - Provider Enrollment: Regulatory Changes (Jan 2023) for additional information.

Medicare Provider Enrollment Print

What’s Changed?

CMS added dates when PECOS and Electronic Health Records (EHR) users must use Multi-Factor Authentication (MFA)
We explained new PECOS scroll functionality

You’ll find substantive content updates in dark red font.

Application Fee

Physicians, Non-Physician Practitioners (NPPs), physician organizations, and non-physician organizations don’t pay a Medicare enrollment application fee.

Generally, institutional providers and suppliers like Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers and Opioid Treatment Programs (OTPs) pay an application fee when enrolling, re-enrolling, revalidating, or adding a new practice location.

Verify which fee and when providers pay it using the Application Fee Requirements for Institutional Providers document.

Enrollment Application Fee

The 2022 enrollment application fee is $631. The Medicare Enrollment Application Information webpage has more information.

Beginning January 1, 2022, CMS no longer requires enrolling Medicare Diabetes Prevention Program (MDPP) suppliers to pay the provider enrollment application fee.

Whether you apply for Medicare enrollment online or use the paper application, you must pay the application fee online:

Online PECOS Application: During the application process, PECOS prompts you to pay the application fee
CMS Paper Application: Go to the Medicare Enrollment Application Information webpage to submit the application fee online

You may request a hardship exception when submitting your Medicare enrollment application via PECOS or CMS paper form. You must submit a written request with supporting documentation with your enrollment application describing the hardship and justifying an exception instead of paying the application fee. CMS grants exceptions on a case-by-case basis.

Medicare Administrative Contractors (MACs) don’t process applications without the proper application fee payment or an approved hardship exception.

If you don’t pay the fee or submit a hardship exception request, your MAC sends a letter allowing you 30 days to pay the fee. If you don’t pay the fee on time, the MAC may reject or deny your application or revoke billing privileges as appropriate.

Medicare providers must enroll in the Medicare Program to get paid for providing covered services to Medicare patients. Learn how to determine if you’re eligible to enroll and how to complete enrollment.

We list institutional providers on the Medicare Enrollment Application: Institutional Providers (CMS-855A) . Institutional providers include:

Community Mental Health Centers (CMHCs)
Comprehensive Outpatient Rehabilitation Facilities (CORFs)
Critical Access Hospitals (CAHs)
ESRD Facilities
Federally Qualified Health Centers (FQHCs)
Histocompatibility Labs
Home Health Agencies (HHAs)
Hospice Organizations
Indian Health Service (IHS) Facilities
Organ Procurement Organizations
Opioid Treatment Programs (OTPs)
Outpatient Physical Therapy, Occupational Therapy, Speech Pathology Services
Religious Non-Medical Health Care Institutions
Rural Health Clinics (RHCs)
Skilled Nursing Facilities (SNFs)

Physicians, NPPs, clinics or group practices, and specific suppliers who can enroll as Medicare Part B providers are defined in enrollment forms Medicare Enrollment Application: Physicians and Non-Physician Practitioners (CMS-855I) and CMS-855B .

Who’s an NPP?

NPPs include nurse practitioners, clinical nurse specialists, and physician assistants who practice with or under a physician’s supervision.

Physicians, NPPs, & Suppliers (CMS-855I)

Anesthesiology Assistants
Audiologists
Certified Nurse-Midwives
Certified Registered Nurse Anesthetists
Clinical Nurse Specialists
Clinical Social Workers
Mass Immunization Roster Billers (individuals)
Nurse Practitioners
Occupational or Physical Therapists in private practice
Physicians (Doctors of Medicine or Osteopathy; Doctors of Dental Medicine; Dental Surgery; Podiatric Medicine; Chiropractic Medicine, or Optometry)
Physician Assistants
Psychologist (clinical)
Psychologists billing independently
Registered Dietitians or Nutrition Professionals
Speech-Language Pathologists

Clinics, Group Practices, & Specific Suppliers (CMS-855B)

Ambulance Service Suppliers
Ambulatory Surgical Centers (ASCs)
Clinics and Group Practices
Hospital Department(s)
Home Infusion Therapy Suppliers
Independent Clinical Labs
Independent Diagnostic Testing Facilities (IDTFs)
Intensive Cardiac Rehabilitation suppliers
Mammography centers
Mass Immunization Roster Billers (entities)
Physical or Occupational Therapy Group in private practice
Portable X-ray suppliers
Radiation Therapy centers

MDPP Suppliers

MDPP suppliers must use Medicare Enrollment Application: Medicare Diabetes Prevention Program (MDPP) Suppliers (CMS-20134) to enroll in the Medicare Program.

If you don’t see your provider type listed, contact your Medicare Administrative Contractor’s (MAC’s) provider enrollment center before submitting a Medicare enrollment application. For your state’s MAC contact information, refer to the Medicare Fee-for-Service Provider Enrollment Contact List .

Medicare provider and supplier organizations have business structures, such as corporations, partnerships, Professional Associations (PAs), or Limited Liability Companies (LLCs) that meet the provider and supplier definitions. Provider and supplier organizations don’t include organizations the IRS defines as sole proprietorships.

Provider and supplier organizations include:

Medical group practices and clinics
Portable X-ray Suppliers (PXRSs)

You must have a provider or supplier Employer Identification Number (EIN) to enroll in Medicare. An EIN is the same as the provider or supplier organization’s IRS-issued Taxpayer Identification Number (TIN).

Sole Proprietorships & Disregarded Entities

Section 10.6.4 and 10.6.7.1(D)(5) of Medicare Program Integrity Manual, Chapter 10 has more information about sole proprietorships and disregarded entities.

Medicare participation means you agree to accept claims assignment for all covered patient services. By accepting assignment, you agree to accept Medicare-allowed amounts as payment in full. You can’t collect more from the patient than the Medicare deductible and coinsurance or copayment . The Social Security Act says you must submit patient Medicare claims whether you participate or not.

To participate as a Medicare Program provider or supplier, submit the Medicare Participating Physician or Supplier Agreement (CMS-460) upon initial enrollment. You have 90 days after we send your initial enrollment approval letter to decide if you want to be a participating provider or supplier. The only other time you may change your participation status is during the open enrollment period, generally from mid-November–December 31 each year.

Participating Provider or Supplier

We pay 5% more to participating physicians and other suppliers
Because these are assigned claims, we pay you directly
We forward claim information to Medigap (Medicare supplement coverage) insurers

Non-Participating Provider or Supplier

We pay 5% less to non-participating physicians and other suppliers
You can’t charge patients more than the limiting charge, 115% of the Medicare Physician Fee Schedule amount
You may accept assignment on a case-by-case basis
You have limited appeal rights

Medicare Claims Processing Manual, Chapter 12 has more information.

Step 1: Get an NPI

You must get an NPI before enrolling in the Medicare Program. Apply for an NPI through 1 of these ways:

Online Application: Get an Identity & Access Management (I&A) System user account. Then apply for an NPI in the National Plan and Provider Enumeration System (NPPES) .
Paper Application: Complete, sign, and mail the NPI Application/Update (CMS-10114) paper application to the address on the NPI Enumerator form. To request a hard copy application, call 1-800-465-3203 (TTY 1-800-692-2326) or email [email protected] .
Bulk Enumeration: Apply for Electronic File Interchange (EFI) access and upload your own Comma-Separated Values (CSV) files.

Not Sure If You Have an NPI?

Search for your NPI on the NPPES NPI Registry .

Multi-Factor Authentication

To better protect your information, we started I&A System Multi-Factor Authentication (MFA) for these public facing applications:

I&A (started September 2019)
NPPES (started December 2019)
PECOS (started January 2022)
Electronic Health Records (EHR) (started April 2022)

CMS Provider Enrollment Systems:

Identity & Access Management (I&A) System
National Plan and Provider Enumeration System (NPPES)
Electronic Health Record (EHR) Incentive Payments

Institutional providers must choose an I&A System Authorized Official (AO) to work in CMS systems. AOs may authorize I&A Access Managers, surrogates, and Staff End Users (SEUs) to also work in CMS systems.

Step 2: Complete Proper Medicare Enrollment Application

After you get an NPI, you can complete Medicare Program enrollment, revalidate your enrollment, or change your enrollment information. Before applying, get the necessary enrollment information . Complete the actions using PECOS or the paper enrollment form.

A. Online PECOS Application

After we approve your I&A System registration, submit your PECOS application.

PECOS offers a scenario-driven application. It asks questions to recover the information for your specific enrollment scenario. You can use PECOS to submit all supporting documentation. Follow these instructions:

Log in to PECOS .
Continue with an existing enrollment or create a new application.
When PECOS determines your enrollment scenario and you confirm it’s correct, you’ll see the topics for submitting your application. To complete each topic, enter the necessary information.
Confirms you entered all necessary data
Lists MAC documents to submit for review
Gives the option to electronically sign and certify
Shows your MAC’s name and mailing address
Lets you print your enrollment application for your records; don’t submit a paper copy to your MAC
Sends the application electronically to your MAC
Emails you to confirm the MAC got the application

When you electronically submit your PECOS application, it’s locked , meaning you can’t edit it unless your MAC requests corrections.

PECOS Scroll Functionality

Starting in July 2022, PECOS validates that you’ve read and acknowledged certification terms and conditions before you electronically submit your Medicare enrollment application. You must review and scroll through each text box with certification requirements before you can click accept on these pages:

Remote E-sign

Enrolling physicians, NPPs, or other Part B suppliers must choose 1 of the application descriptions below. Choose the Group Member Only if you’re re-assigning all your benefits to a group practice or clinic.

Sole Owner of a Professional Association (PA), Professional Corporation (PC), or Limited Liability Company (LLC): You’re the only owner of a business, set up as a corporation, where you provide health care services. Your business is legally separate from your personal assets.
Self-Employed or Sole Proprietor: You provide all health care services from a facility you own, lease, or rent. You’re the only owner of a business that provides health care services. You and your business are legally one and the same. You’re personally responsible for the business’ financial obligations. You report the business’ income and losses on your personal tax return.
Group Member Only: You provide all health care services as an employee of a group practice or clinic. You arrange with your employer to submit claims and get paid for your services.
Group Member and Self-Employed: You provide health care services as a group practice or clinic employee. You agree with your employer to submit claims and get paid for your services. You also provide health care services from a facility that you own, lease, or rent. Your income through self-employment is part of your personal assets.
Disregarded Entity: You’re the only owner of a business, set up as a corporation, where you provide health care services. Your corporation doesn’t file taxes; instead, you file corporate taxes on your personal tax filing.

B. Paper Medicare Enrollment Applications

Submit the appropriate paper enrollment application if you’re unable to use PECOS. Carefully review the paper application instructions to decide which form is right for your practice. The paper enrollment application collects your information, including documentation verifying your Medicare Program enrollment eligibility.

If you submit a paper application, your MAC processes your approved Medicare enrollment and creates a PECOS record.

Medicare Enrollment Application: Institutional Providers (CMS-855A) : Institutional providers use this form to begin the Medicare enrollment or revalidation process or change enrollment information.
Medicare Enrollment Application: Physicians and Non-Physician Practitioners (CMS-855I) : Individual physicians or NPPs, as well as individual physicians and NPPs that are sole proprietors or sole owners of a corporation that provides services, use this form to begin the Medicare enrollment or revalidation process, or change enrollment information.

Most physicians and NPPs complete CMS-855I to begin the enrollment process. If you reassign your benefits to another entity, like a medical group or group practice that gets paid for your services, you must complete CMS-855R or the associated PECOS enrollment applications.

Medicare Enrollment Application: Clinics/Group Practices and Certain Other Suppliers (CMS-855B) : Group practices and other organizational suppliers, except DMEPOS suppliers, use this form to begin the Medicare enrollment or revalidation process, or change enrollment information.
Medicare Enrollment Application: Eligible Ordering, Certifying, and Prescribing Physicians and Other Eligible Professionals (CMS-855O) : Physicians and other eligible NPPs use this form to enroll in Medicare solely to order or certify items or services for Medicare patients. This includes those physicians and other eligible NPPs who don’t send billed services claims to a MAC.
Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (CMS-855S) : DMEPOS suppliers use this form to begin the Medicare enrollment or revalidation process, or change enrollment information.
Medicare Enrollment Application: Medicare Diabetes Prevention Program (MDPP) Suppliers (CMS-20134) : MDPP suppliers use this form to begin the Medicare enrollment or revalidation process, or change enrollment information.

After you submit an enrollment application and all required supporting documentation to your MAC, they’ll send their recommendations to the State Survey Agency and CMS. CMS decides if specific providers meet Medicare enrollment conditions.

After a MAC makes a recommendation, the State Survey Agency or a CMS-recognized Accrediting Organization (AO) conducts a survey. Based on the survey results, the agency or organization recommends that CMS approve or deny the enrollment (certification of compliance or non-compliance).

Certain institutional provider types may elect voluntary accreditation by a CMS-recognized AO instead of a State Survey Agency. You must notify the State Survey Agency of the AO’s decision.

The State Survey Agency forwards survey results to CMS. CMS approves or denies the enrollment application, supporting documentation, and survey results, and works with the Office for Civil Rights to get necessary clearances.

If approved, you must sign a provider agreement.

Electronic Funds Transfer

If enrolling in Medicare, revalidating, or making certain changes to your enrollment, CMS requires you set up Electronic Funds Transfer (EFT). Enroll in EFT by completing the PECOS EFT information section. When submitting a PECOS web application:

Complete EFT information for your organization (if appropriate) or as an individual
Include copy of voided check or bank letter that has your individual or business legal name
Include applicable account and routing numbers

Step 3: Respond to Requests for More Information

MACs pre-screen and verify enrollment applications but may need additional information. Respond to information requests within 30 days; otherwise, the MAC may reject your enrollment for any of the reasons listed in 42 CFR 424.525 . MACs may return your application for any of the reasons listed in 42 CFR 424.526 .

Your MAC won’t fully process your PECOS enrollment application without your electronic or uploaded signature, application fee (if applicable), and necessary supporting documentation. The application enrollment filing date is when the MAC gets your enrollment application.

You can check your PECOS enrollment application status 2 ways:

Log in to PECOS and select the View Enrollments link. In the Existing Enrollments section, find the application. The system shows the application status.
To see your enrollment status without logging in, go to PECOS and, under Helpful Links , select Application Status.

When your MAC approves your application, it switches the PECOS record to an approved status and sends you an approval letter.

Provider Enrollment Site Visits

CMS conducts a site visit verification process using a National Site Visit Contractor (NSVC). A site visit helps prevent questionable providers and suppliers from enrolling or staying enrolled in the Medicare Program. The NSVC conducts unannounced site visits for all Medicare Part A and B providers and suppliers, including DMEPOS suppliers. The NSVC may conduct an observational site visit or a detailed review to verify enrollment-related information and collect other details based on pre-defined CMS checklists and procedures.

During an observational visit, the inspector has minimal contact with the provider or supplier and doesn’t hinder the facility’s daily activities. The inspector may take facility photographs as part of the site visit. During a detailed review, the inspector enters the facility, speaks with staff, takes photographs, and collects information to confirm the provider’s or supplier’s compliance with CMS standards.

Inspectors performing site visits will carry a photo ID and a CMS-issued, signed authorization letter the provider or supplier may review. If the provider or its staff want to verify CMS ordered a site visit, contact your MAC .

Make your office staff aware of the site visit verification process. An inspector’s inability to perform a site visit may result in your Medicare enrollment application denial or Medicare billing privileges revocation.

Step 4: Use PECOS to Keep Enrollment Information Current

Report a Medicare enrollment change using PECOS. Providers and suppliers must report a change of ownership or control, a change in practice location, and final adverse legal actions (such as revocation or suspension of a federal or state license) within 30 days of the change and report all other changes within 90 days of the change.

DMEPOS suppliers must report changes in their enrollment application information within 30 days of the change.

Independent Diagnostic Testing Facilities (IDTFs) must report changes in ownership, location, general supervision, and adverse legal actions within 30 days of the change and report all other changes within 90 days of the change.

MDPP providers must report changes in ownership including AO or Access Manager, location, coach roster, and adverse legal actions within 30 days of the change and report all other changes within 90 days of the change.

MLN Matters® Article SE1617 has more information on reporting changes to your MAC.

PECOS Users

We allow various organizations and users to work in our systems. The type of user depends on the individual’s relationship with you and the duties they perform in your practice.

You may choose other users to act for your organization to manage connections and staff, including appointing and approving other system-authorized users. Depending on your professional relationships with other providers, the CMS External User Services (EUS) Help Desk may ask you for additional validation information.

One Account, Multiple Systems

We use several provider enrollment systems. Organizational providers and suppliers must use the Identity & Access Management (I&A) System to name an Authorized Official (AO) to work in CMS systems. The I&A System allows you to:

Use the National Plan and Provider Enumeration System (NPPES) to apply for and manage NPIs
Use PECOS to complete Medicare enrollment or update or revalidate your current enrollment information
Register to get Electronic Health Record (EHR) incentive payments for eligible professionals and hospitals that adopt, use and upgrade, or show meaningful EHR technology

Authorized Officials, Access Managers, Staff End Users, & Surrogates

Organizational providers or suppliers must appoint and authenticate an AO through the I&A System to work in PECOS for them. That individual must meet the AO regulatory definition. For example, an AO is a chief executive officer, chief financial officer, general partner, chair of the board, or direct owner who can legally enroll in the Medicare Program.

Respond to your employer’s AO invitation or initiate the request yourself. After you’re the confirmed AO, use PECOS for your provider or supplier organization. As an AO, you’re responsible for approving PECOS user system requests to work on behalf of the provider or supplier organization. Regularly check your email and take the requested actions.

AOs may delegate their responsibilities to an Access Manager , who can also initiate or accept connections, and manage staff for their organizations.

AOs or Acess Managers may invite a Staff End User (SEU) or Surrogate to access PECOS for their organization. Once registered, an SEU or Surrogate may log in to access, view, and modify CMS system information, but they can’t represent the practice, manage staff, sign enrollment applications, or initiate or accept connections.

We recommend using the same I&A System-appointed AO and any PECOS Access Managers. The assigned AO and Access Managers must have the right to legally bind the company, are responsible for approving the system staff, and are CMS-approved in the I&A System.

Only AOs can sign an initial organization enrollment application. An Access Manager can sign changes, updates, and revalidations.

I&A System Quick Reference Guide has detailed instructions on managing system users.

PECOS Technical Help

Using PECOS may require technical support. Knowing which CMS contractor to contact is the first step toward a solution.

Common Problems and Who to Contact

You experience system-generated error messages, trouble navigating through PECOS screens, issues accessing PECOS, printing problems, or your valid Identity & Access Management (I&A) System user ID and password won’t allow PECOS access because of malfunction (for example, the website operates slowly or not at all, or a system-generated error message prevents data entry).

A system-generated error message doesn’t include messages created when you enter data incorrectly or ignore system prompts.

Solution: Contact CMS External User Services Help Desk

External User Services (EUS) website has information on common problems and allows you to ask questions or look up previous support history.

Phone: 1-866-484-8049 (TTY 1-866-523-4759)

Email: [email protected]

Live Chat: Go to the EUS website, and on the right side select Ask a Question , then Live Chat .

EUS Hours of Operation: Monday–Friday, 6 am–6 pm CT; Saturday–Sunday, closed

Before you log in to PECOS, you need a valid I&A System user ID and password.

Passwords expire every 60 days. You can’t log in to the I&A System (and PECOS) until you reset your password. The I&A System tells you the number of days until your password expires. Go to the My Profile tab and see the password section. If you attempt to log in to PECOS with an expired password, the system redirects you to the I&A System to reset it.

Solution: Access I&A System or Contact I&A System Help

The I&A System website lets you create an I&A System user ID and password, change your password, and recover forgotten login information. You can also access several resources:

I&A FAQs helps you resolve common I&A System problems
I&A System Quick Reference Guide provides step-by-step instructions, including screenshots about I&A System features and tools

On the I&A System website, select the Help button in the upper right corner of any webpage for more information on that webpage’s topic.

While using PECOS, you have questions, experience problems enrolling, or need guidance on completing specific PECOS enrollment application sections.

Solution: Contact Your Medicare Enrollment Contractor

Find detailed enrollment contact information in the Medicare Provider Enrollment Contact List or if you have questions, find your MAC’s website .

Solution: Refer to the CMS Provider Enrollment Assistance Guide

If you don’t know who to call for help, refer to the “Who should I call?” CMS Provider Enrollment Assistance Guide .

CMS uses several provider enrollment systems. Specifically, the Identity & Access Management (I&A) System allows you to:

Apply for and manage NPIs in the National Plan and Provider Enumeration System (NPPES)
Use PECOS to enroll in Medicare or update or revalidate your current enrollment information
Register to get Electronic Health Record (EHR) incentive payments for eligible professionals and hospitals that adopt, use and upgrade, or show meaningful use with certified EHR technology

Before completing PECOS enrollment, you must have an I&A System account. Organizational providers and suppliers must designate an Authorized Official (AO) to work in these systems.

Organizational providers and suppliers must designate a provider enrollment AO to work in CMS systems. These systems include the I&A System , NPPES , and PECOS . The AO may also authorize Access Managers, surrogates, and Staff End Users (SEUs) to use PECOS. Individual providers and suppliers don’t require an AO but can authorize surrogates and SEUs to work in PECOS. For more information on registering for an I&A System account or enrolling as an AO, refer to the I&A System Quick Reference Guide and I&A FAQs .

Use the same information to enroll in Medicare using PECOS as you would for a paper enrollment application. If you don’t have an I&A System account, create your username and password. Use your username and password to log in to NPPES to register for an NPI. All Medicare provider enrollees must have an active NPI.

Based on your provider type, you may also need this information:

Personal identifying information, including your legal name on file with the Social Security Administration (SSA), date of birth, and SSN
Legal Business Name (LBN) of the provider or supplier organization
Tax Identification Number (TIN) of the provider or supplier organization
Professional license information
School degrees
Certificates
Accreditation information
Surety Bond information
Specialty and secondary specialty information
Current medical practice location
Federal, state, and local (city or county) business and professional licenses, certificates, and registrations specifically required to operate as a health care facility
Medical record storage information
Special payment information
Bank account information
Medicare-imposed revocation of billing privileges
Suspension, termination, or revocation of a license to provide health care by a state licensing authority or the Medicaid Program
Conviction of a federal or state felony within 10 years before enrollment, revalidation, or re-enrollment
Exclusion or debarment from federal or state health care program participation by the Office of Inspector General (OIG) or other federal or state offices with authority to exclude or sanction a provider

42 CFR 424.535 has more information on revocation of enrollment in the Medicare Program.

An application is the paper or electronic form you submit for Medicare Program enrollment approval. After the MAC processes the application, PECOS keeps the enrollment record that includes all your enrollment application data.

You can’t use PECOS to:

Change your SSN
Change a provider’s or supplier’s TIN
Solely owned Professional Association (PA), Professional Corporation (PC), or Limited Liability Company (LLC) can’t be changed to a sole proprietorship
Sole proprietorship can’t be changed to a PA, PC, or LLC
Reassign benefits to an unenrolled PECOS provider

Submit changes noted above using the appropriate paper Medicare enrollment application .

No. All Fee-for-Service (FFS) providers can apply in PECOS.

The PECOS Provider Interface is available 24 hours a day, Monday–Saturday, with scheduled downtime on Sunday. CMS technical support is available daily 5 am–8 pm CT.

We prefer you submit your enrollment application through PECOS because it’s faster and easier, but you may complete and mail the appropriate paper Medicare enrollment application to the address on the Medicare Fee-for-Service Provider Enrollment Contact List :

Parts A and B Providers: Send forms to your Part A or Part B Medicare Administrative Contractor (MAC)
Home Health and Hospice Providers: Send forms to the Home Health and Hospice Contractor
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers: Send forms to the National Supplier Clearinghouse (NSC)

Even if you submit your application on a paper form, your MAC creates an enrollment record in PECOS.

When you electronically submit your Medicare enrollment application, you’ll get a Submission Confirmation page. The Submission Confirmation page reminds you that the individual provider, or the provider or supplier organization AO/Access Manager, must electronically sign the application or upload their signature.

PECOS emails each address in the Contact Person section of the application of the web tracking ID for the submitted application. Remember to verify all your completed signatures with either an electronic signature or uploading certification. Mail required supporting documentation not uploaded before submission to the MAC with reference to the PECOS tracking ID.

When to create a new enrollment:

If you change your services, such as changing specialties
If you change your location where your MAC may need new state surveys and other documentation (your MAC can determine if you need a new enrollment based on a new state survey or other documentation)
If you have provider-based vs. freestanding requirements; for more information, find your MAC’s website .

Application Fee & Supporting Documentation

Generally, institutional providers, DMEPOS suppliers, and Opioid Treatment Programs (OTPs) pay an application fee when enrolling, re-enrolling, revalidating, or adding a new practice location. Verify which fee and when providers pay it using the Application Fee Requirements for Institutional Providers document.

An approved hardship exception exempts you from paying the application fee for the current application. If you request a hardship exception, you must submit the written request (and supporting documentation) describing the hardship and why the hardship justifies an exception with your CMS paper application or PECOS application. CMS decides whether to grant these requests on a case-by-case basis.

MACs won’t process applications without the proper application fee or an approved hardship exception.

If you don’t pay the fee or submit a hardship exception request when you submit your enrollment application, your MAC will send a letter explaining if you don’t pay the application fee through the Medicare Enrollment Application Information webpage within 30 days from the date of the letter, they may reject your application or revoke your existing billing privileges.

If you pay the fee during the 30-day period, the MAC processes the application in the usual manner.

No. When you electronically submit the provider or supplier organization’s Medicare enrollment application, a page appears that lists the supporting documentation to complete the enrollment. You may submit all this documentation electronically through PECOS.

Yes, either is acceptable. You must send this information electronically (as supporting documentation uploaded into PECOS).

During the PECOS application process, the Penalties for Falsifying Information page has the same text as the paper Medicare enrollment application and lists the consequences for providing false information. These consequences include criminal and civil penalties, fines, civil monetary penalties, exclusion from federal health care programs, and imprisonment, among others. You must acknowledge the Penalties for Falsifying Information page by selecting the Next Page button before continuing the PECOS submission process.

Enrollment Application Issues

First, make sure you entered your correct SSN, legal name, and date of birth. If you believe you entered the correct information, but PECOS doesn’t accept this information, contact SSA .

You must report an SSN to enroll in Medicare. If you don’t want to report your SSN over the web, use the appropriate paper Medicare enrollment application .

An Invalid Address error indicates the address entered doesn’t comply with the U.S. Postal Service address standards. This page lets you continue by either saving the address you entered or selecting the address PECOS displays.

As a security feature, PECOS will time out if you’re inactive (you don’t hit any keys on your computer keyboard) for 15 minutes. The system warns you of inactivity after 10 minutes, and if it gets no response after 5 additional minutes, the system automatically logs you off. Save your work if you anticipate inactivity while applying in PECOS. If you don’t save your work and the system times out, you must start from the beginning.

Submitting Reportable Events

No. If you report a change to existing information, check Change , include the effective date of change, and complete the appropriate fields in the sections that changed.

Yes. Following your initial enrollment, you must report certain changes (reportable events) to the MAC within 30 calendar days of the change. Report all other changes to your MAC within 90 days.

Report a Medicare enrollment change using PECOS. Physicians and NPPs must report a change of ownership or control, a change in practice location, and any final adverse legal actions (such as revocation or suspension of a federal or state license) within 30 days of the change and report all other changes within 90 days of the change.

DMEPOS suppliers must report changes in information on their enrollment application within 30 days of the change.

Since Medicare pays claims by EFT, the Special Payments address should indicate where all other payment information must go (for example, paper remittance notices or special payments).

Providers and suppliers should report most changes using PECOS or the applicable paper Medicare enrollment application .

No. If you have a new business location, complete a new PECOS or paper application. Each DMEPOS enrollment record can only have 1 current business location.

Revalidations

Revalidation means resubmitting and recertifying your enrollment information.

DMEPOS suppliers must revalidate every 3 years. All other providers and suppliers generally revalidate every 5 years. CMS can also conduct off-cycle revalidations according to 42 CFR 424.515 . You can revalidate using PECOS or by submitting the appropriate Medicare enrollment application .

If currently enrolled, check the Medicare Revalidation Lookup Tool to find your revalidation due date. If you see a due date, submit your revalidation prior to that date. Your MAC will also send you a revalidation notice.

Due dates are:

Updated in the Medicare Revalidation Lookup Tool every 60 days at the beginning of the month
Listed up to 7 months in advance or listed as to be determined (TBD) if more than 7 months before the due date

Yes. Your MAC will send a revalidation notice as early as possible, generally no later than 3–4 months before your revalidation due date.

If there’s no listed due date on the Medicare Revalidation Lookup Tool or you didn’t get a MAC letter requesting revalidation, don’t submit your revalidation application. Your MAC will return these revalidation applications to you.

However, if you’re within 2 months of the due date listed on the Medicare Revalidation Lookup Tool and didn’t get a MAC notice to revalidate, submit your revalidation application.

Yes. Using PECOS to revalidate lets you review information on file and update and submit your revalidation electronically. If you use PECOS, you need to update only changed information.

If you submit your revalidation after the due date, the MAC may place a hold on your Medicare payments or deactivate your Medicare billing privileges. If the MAC requests additional documentation, respond within 30 days; otherwise, they may deactivate your Medicare billing privileges. We may deactivate your billing privileges for any of the reasons listed in 42 CFR 424.540 .

Revalidation ensures all provider enrollment records are accurate and current. Generally, we don’t take administrative action against a provider or supplier for updating their records even though it wasn’t timely. However, we could take administrative actions, including recovery of prior Medicare payments, when a provider or supplier failing to report the change causes Medicare Program enrollment ineligibility.

PECOS users can no longer mail documents that require a signature. When submitting your application, be prepared to send an e-signature or upload your signed documents.

Protect Your Identity & Privacy

You can help protect your professional medical identifiers from identity thieves attempting to defraud the Medicare Program.

PECOS is an electronic Medicare enrollment system where providers and suppliers can:

Submit Medicare enrollment applications
View and print enrollment information
Update enrollment information
Complete the enrollment revalidation process
Voluntarily withdraw from the Medicare Program
Track a Medicare enrollment application

This protects your Medicare enrollment information.

Keep PECOS Enrollment Information Current

Log in to PECOS and review your Medicare enrollment information several times a year to ensure there are no unauthorized changes.

PECOS Provides Security

Only you, authorized surrogates, authorized CMS officials, and Medicare Administrative Contractors (MACs) may enter and view your Medicare PECOS enrollment information. CMS officials and MACs get security standards training and must protect your information. We don’t disclose your Medicare enrollment information to anyone, except when authorized or required by law.

Review & Protect Enrollment Information

Review your Medicare enrollment information in PECOS frequently to ensure it’s accurate, current, and unaltered.

Protect Yourself & CMS Programs from Fraud

Your NPI and Tax ID are publicly available information. Use extra caution to monitor and protect your professional and personal information to help prevent fraud and abuse. You must also ensure your patients’ personal health information is secure. We have these resources:

Medicare Fraud & Abuse: Prevent, Detect, Report
Office of Inspector General
Help Fight Medicare Fraud (for patients)

Use your Identity & Access Management (I&A) System user ID and password to access PECOS. Keep your ID and password secure. Take these steps to verify your Medicare enrollment information:

Ensure Your Enrollment Record is Accurate

Accurate and complete PECOS data is critical to CMS business functions, including the ability to:

Combat fraud, waste, and abuse in Medicare and other health care programs
Make informed provider enrollment decisions
Pay claims accurately

Update and review your provider enrollment information whenever you make a change to your practice, including address changes .

Report suspicious information (for example, information you didn’t submit) to your MAC provider enrollment division.

Existing Medicare Applications and Enrollments

If you suspect your PECOS profile is incorrect due to unauthorized account access, contact your MAC, law enforcement authorities, and your bank. Your MAC and bank can flag your respective accounts for possible fraudulent activity and law enforcement can begin investigating if and how your accounts were compromised.

Additional Privacy Tips

Take these additional actions to protect your Medicare enrollment information:

Change your password in the I&A System before accessing PECOS the first time. You can’t change your user ID, but you must change your password every 60 days.
Review your Medicare enrollment information several times a year to ensure no one changed information without your knowledge. Immediately report changes you didn’t submit.
Maintain your Medicare enrollment record. You must report Medicare enrollment changes known as reportable events. Reportable events include change of ownership or control , change in practice location, banking arrangements, and any final adverse legal actions.
Store PECOS copies or paper enrollment applications in a secure location. Don’t allow others access to this information. It contains your personal information, including your date of birth and SSN. Don’t leave copies on a copy machine or on your workspace.
Enroll in electronic Medicare payments and ensure they deposit directly into your bank account. We require all providers use Electronic Funds Transfer (EFT) if enrolling in Medicare, revalidating, or making changes to their enrollment. The most efficient way to enroll in EFT is to complete the EFT information section in PECOS and provide required supporting documentation. Using EFT allows us to send payments directly to your bank account.

DMEPOS Supplier Requirements

Dmepos supplier standards, accreditation, & surety bond.

To enroll or keep your Medicare billing privileges, all DMEPOS suppliers (except certain exempted professionals) must meet supplier and DMEPOS Quality Standards to become accredited. Certain DMEPOS suppliers must also submit a surety bond .

DMEPOS suppliers (except those exempted eligible professionals and other persons) must be accredited by a CMS-approved Accrediting Organization before submitting a Medicare enrollment application to the National Supplier Clearinghouse (NSC). CMS DMEPOS Enrollment webpage highlights these conditions. DMEPOS Accreditation fact sheet lists exempted eligible professionals.

Each enrolled DMEPOS supplier covered under the Health Insurance Portability and Accountability Act (HIPAA) must name each practice location (if it has more than 1) as a sub-part and make sure each sub-part gets its own NPI.

Individual DMEPOS Suppliers (for example, sole proprietorships)

Physicians, Non-Physician Practitioners (NPPs), and DMEPOS suppliers may use their Identity & Access Management (I&A) System user ID and password to access PECOS . If you don’t already have an I&A System account, refer to the I&A System User Registration page and enter the information to open an account. For help, refer to the I&A System Quick Reference Guide and select the How to Set Up Your Account if you’re a Sole Owner link.

As an individual DMEPOS supplier, you don’t need an Authorized Official (AO) or another authorized user.

Organizational DMEPOS Suppliers System Users

A DMEPOS supplier organization must appoint an AO to manage connections and staff, including appointing and approving other authorized PECOS users. The organization must identify the AO in the enrollment application. The AO must have ownership or managing control in the DMEPOS supplier organization.

Providers Who Solely Order or Certify

Physicians and other eligible professionals must enroll in the Medicare Program or have a valid opt-out affidavit on file to solely order or certify Medicare patient items or services.

Those physicians and other eligible professionals enrolled solely as ordering or certifying providers don’t send billed service claims to a Medicare Administrative Contractor (MAC).

Ordering & Certifying Terms

Medicare Part B claims use the term ordering/certifying provider to identify the professional who orders or certifies an item or service reported in a claim. These are technically correct terms:

Providers order non-physician patient items or services, such as Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); clinical lab services; or imaging services
Providers certify patient home health services

The health care industry uses the terms ordered , referred , and certified interchangeably. Find terminology comments in the Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements Final Rule .

Who Are Eligible Ordering or Certifying Providers?

Physicians or eligible professionals who order or certify Part A or Part B services but don’t want to submit Medicare claims are eligible ordering or certifying providers.

An individual already enrolled as a Medicare Part B provider may submit claims listing themselves as the ordering or certifying provider without re-enrolling using Medicare Enrollment Application: Eligible Ordering, Certifying and Prescribing Physicians, and other Eligible Professionals (CMS-855O) .

Those who enroll as eligible providers using CMS-855O can’t bill Medicare or get paid by us for their services. They have no Medicare billing privileges.

Eligible providers must meet these basic conditions:

Have an individual NPI
Be enrolled in Medicare in either an approved or opt-out status
Be an eligible specialty type to order or certify

Organizational NPIs don’t qualify and you can’t use them to order or certify.

Denial of Ordering or Certifying Claims

If claims lack a valid individual NPI, MACs deny them if they’re from:

Clinical labs for ordered tests
Imaging centers for ordered imaging procedures
DMEPOS suppliers for ordered DMEPOS
Part A HHAs that aren’t ordered or certified by a Doctor of Medicine (MD), Doctor of Osteopathy (DO), or Doctor of Podiatric Medicine (DPM)

If you bill a service that needs an eligible provider and they aren’t on the claim, the MAC denies the claim. The claim must have a valid NPI, and the eligible provider’s name as it appears in PECOS.

If a provider on the Preclusion List prescribes a drug, Part D plans deny Part D covered drugs.

Requirement 1: You Must Have an Individual NPI

There are 2 types of NPIs: Type 1 (individual) and Type 2 (organizational). Medicare allows only Type 1 NPIs to solely order items or certify services. Apply for an NPI through:

Paper Application: Complete, sign, and mail the NPI Application/Update Form (CMS-10114 ) paper application to the address on the Enumerator form. To request a hard copy application, call 1-800-465-3203 (TTY 1-800-692-2326), or email [email protected] .
Bulk Enumeration: Apply for Electronic File Interchange (EFI) access and upload your own Comma-Separated Values (CSV) or Extensible Markup Language (XML) files.

Requirement 2: You Must Enroll in Medicare in an Approved or Opt-Out Status

When you have an NPI, use PECOS to verify current Medicare enrollment record information, including your NPI and that you’re approved, or go to the Opt Out Affidavits list to check your status. To opt-out of Medicare, you must submit an affidavit expressing your decision to opt-out of the program.

We no longer require Part C and Part D providers to enroll in Medicare in an approved or opt-out status.

* We deny certain PMD claims if the ordering provider isn’t on Medicare’s eligible providers list.

Requirement 3: You Must Be Eligible to Order or Certify

The physicians and eligible professionals who may enroll in Medicare solely for ordering or certifying include, but aren’t limited to, physicians and eligible professionals who are:

Department of Veterans Affairs (DVA) employees
Public Health Service (PHS) employees
Department of Defense (DOD) or TRICARE employees
Indian Health Service (IHS) or Tribal Organization employees
Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), or Critical Access Hospitals (CAHs) employees
Licensed Residents in an approved medical residency program defined in 42 CFR 413.75(b)
Dentists, including oral surgeons
Pediatricians
Retired, licensed physicians

If you’re unsure whether your specific provider specialty qualifies to enroll as an ordering or certifying provider, refer to Section 4 of CMS-855O or find your MAC’s website before submitting a Medicare enrollment application.

Interns & Residents

Claims for items or services ordered or certified by licensed or unlicensed interns and residents must specify a teaching physician’s NPI and name. State-licensed residents may enroll to order or certify, and claims may list them. If states offer provisional licenses or otherwise permit residents to order or certify, CMS allows interns and residents to enroll consistent with state law.

Requirement 4: Respond to Requests for More Information

MACs pre-screen and verify enrollment applications. During processing, your MAC may need additional information. Respond to information requests within 30 days; otherwise, the MAC may reject your enrollment.

Your MAC won’t fully process your PECOS enrollment application without your electronic or uploaded signature, application fee, and necessary supporting documentation. The effective application enrollment filing date is when the MAC gets your enrollment application.

To see your enrollment status, go to the PECOS homepage and under Helpful Links , select Application Status . You don’t need to log in to PECOS to use this application status feature.

Requirement 5: Use PECOS to Keep Enrollment Information Current

Report a Medicare enrollment change using PECOS. Providers and suppliers must report a change of ownership or control, a change in practice location, and any final adverse legal actions (such as revocation or suspension of a federal or state license) within 30 days of the change and report all other changes within 90 days of the change.

Medicare Diabetes Prevention Program (MDPP) providers must report changes in ownership including AO or Access Manager, location, coach roster, and adverse legal actions within 30 days of the change and report all other changes within 90 days of the change.

Revalidation

Revalidation, or re-submitting and recertifying your enrollment information accuracy, is an important anti-fraud tool. All Medicare-enrolled providers and suppliers must periodically revalidate their enrollment information .

Generally, physicians, including physician organizations, Opioid Treatment Programs (OTPs), Medicare Diabetes Prevention Program (MDPP) suppliers, and institutional providers revalidate enrollment every 5 years or when we request it. Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers must revalidate their enrollment information every 3 years.

PECOS is the most efficient way to revalidate information.

If you’re actively enrolled, go to the Medicare Revalidation Lookup Tool to find your revalidation due date. If you see a due date, submit your revalidation before that date. Your Medicare Administrative Contractor (MAC) notifies you to revalidate. If you submit your revalidation application after the due date, the MAC may hold your Medicare payments or deactivate your billing privileges.

Rebuttal Process

MACs issue Medicare billing privilege deactivations and CMS permits providers and suppliers to file a rebuttal .

Get more information in:

Medicare Provider-Supplier Enrollment and Certification: Revalidations webpage
Provider Enrollment Revalidation Cycle 2 FAQs
42 CFR 424.515

Large Group Coordination

Groups with more than 200 members can use the Medicare Revalidation Lookup Tool and search by their organization’s name to download group information. They will get a letter and spreadsheet from their MAC listing the providers linked to their group who must revalidate within 6 months. Large groups should work together to ensure they submit only 1 application from each provider or supplier.

Use these resources to learn how to enroll in the Medicare Program, revalidate your enrollment, or change your enrollment information. You must enroll in the Medicare Program to get paid for providing covered patient services. You must enroll if you solely order items or certify services, and you won’t submit claims for these services.

You can enroll online by using PECOS or the appropriate paper enrollment application you submit to your Medicare Administrative Contractor (MAC).

Get an Identity & Access Management (I&A) System user account
Apply for your NPI in the National Plan and Provider Enumeration System (NPPES)
Enroll in PECOS

Enroll in Medicare

Medicare enrollment varies for each provider or supplier type. This tool offers enrollment forms, process descriptions, and resources appropriate to your provider or supplier type.

We encourage you to use PECOS instead of the Medicare paper enrollment application.

PECOS advantages include:

Paperless process, including electronic signature and digital document feature
Faster enrollment
Submitting only relevant information
More control over your enrollment information, including re-assignments
Easy to check and update information
Less staff time and administrative costs

Protect Your Identity & Information

NPIs and Tax IDs are publicly available information. Use extra caution to monitor and protect professional and personal information to help prevent fraud and abuse. This includes securing your patients’ personal health information. CMS has these resources:

Problems Enrolling?

You may have questions or problems that need additional help or technical support.

Enrollment Forms

Medicare makes fillable PDF enrollment forms. If you enroll using a paper application instead of PECOS , search the CMS Forms List for the form you need, select a form, and read Who Should Complete This Application on page 1. Check to ensure you use the correct application.

Additional Resources

Medicare Enrollment for Providers & Suppliers
Provider Enrollment and Certification
Hardship Exception
CMS Fingerprinting Instruction Website

Commonly Used Terms

For a complete list of terms, go to the CMS Glossary .

Medicare Learning Network® Content & Product Disclaimer, and Department of Health & Human Services Disclosure

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).

IMAGES

CMS Site Visits
Contractor Management System (CMS)
On-Site Visits
MLN6922507
CMS Contractor Website
How to Prepare for a Site Visit with a Contractor

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COMMENTS

Medicare Provider Enrollment Print
We conduct a site visit verification process using National Site Visit Contractors (NSVCs). A site visit helps prevent questionable providers and suppliers from enrolling or staying enrolled in the Medicare Program. The NSVCs conduct unannounced site visits for all Medicare Part A and B providers and suppliers, including DMEPOS suppliers.
Medicare Site Visits during Provider Enrollment
The contractor shall order this site visit because the visit will occur at a location (i.e., the branch location) different from the main location (i.e., the location that underwent the February 1 revalidation visit). Example 2 - A DMEPOS supplier undergoes a revalidation site visit on April 1. It submits an initial Form CMS-855S application ...
PDF Provider Enrollment Site Visits
Site Visit Tips 2 Identify if services are provided in patient's homes or in a mobile unit (IDTF) Site visit will be performed at the group's location if you reassign all benefits Refusing a site visit could result in the denial or revocation of your Medicare billing privileges For education on site visit requirements refer to:
National Site Visit Verification (NSV) Initiative
National Site Visit Verification (NSV) Initiative. This MLN Matters® Special Edition Article is intended for all providers and suppliers, that enroll in the Medicare program and submit fee-for-service (FFS) claims to Medicare Administrative Contractors (MACs), including home health and hospice MACs, for services provided to Medicare beneficiaries.
PDF CMS Manual System Department of Health & Transmittal 12852
completion of the NSVC's site visit and the contractor's review of the results. R. Mobile Units Mobile units must list their geographic service areas in Section 4 of the Form CMS-855B. Based on the information furnished therein, the NSVC will generally perform the site visit
How can I be sure the individual present to conduct the site visit is
One contractor conducts site visits in states east of the Mississippi River and the other, states west of the river. Each contractor may use subcontractors to perform inspections. Regardless, an authorized site inspector will have photo identification and a signed letter on CMS letterhead authorizing the individual to conduct the visit.
Site Visits Screen Providers and Suppliers When Enrolling in Medicare
The site visit verification process is a screening mechanism to prevent questionable providers - and suppliers - from enrolling in Medicare. Providers and suppliers will be screened by the Centers of Medicare & Medicaid Services (CMS)-designated national site visit contractor, with the exception of Durable Medical Equipment suppliers which ...
CMS awards extension to National Site Visit Contractor
CMS awards extension to National Site Visit Contractor. Notice ID: GS-15F-0059MHHSM-500-2012-00009G. Contract: GS-15F-0059M. The Centers for Medicare & Medicaid Services (CMS) implemented certain provisions of the Affordable Care Act to establish additional screening requirements for providers/suppliers. The CMS Rule 6028-FC published February ...
Medicare Provider Enrollment
In 2011, CMS implemented a site visit verification process using a National Site Visit Contractor (NSVC). A site visit is a screening to prevent questionable providers and suppliers from enrolling or staying enrolled in the Medicare Program. The NSVC conducts unannounced site visits for all Medicare Part A and B providers and suppliers ...
CMS Site Visits: DME Providers and Suppliers Enrollment Screening
The CMS site visit verification process is a screening mechanism to prevent questionable providers and suppliers from enrolling in Medicare. Providers and suppliers will be screened by the Centers of Medicare & Medicaid Services (CMS) designated national site visit contractor, with the exception of Durable Medical Equipment suppliers which are handled by the National Supplier Clearinghouse.
Strengthening Provider and Supplier Enrollment Screening
In our effort to continuously enhance Medicare program integrity and use information identified by the GAO, CMS is strengthening strategies designed to reinforce provider screening activities, specifically: Utilizing the National Site Visit Contractor (NSVC) to increase the number of site visits to Medicare-enrolled providers and suppliers;
Additional enrollment information for Part B
The scope of the site visit will be consistent with sections 10.6.20(A) and 10.6.20(B) of this chapter. The National site visit contractor (NSVC) will perform the site visit. The contractor shall not convey Medicare billing privileges to the supplier prior to the completion of the NSVC's site visit and the contractor's review of the results ...
CMS Provides Information on SNF Provider Enrollment Site Visit Contractors
The Centers for Medicare and Medicaid Services (CMS) posted an article in the MLN Matters weekly newsletter regarding the two SNF provider enrollment site visit contractors that have been confusing many members because it is a new process. In particular, the site visit contractors often subcontract the persons who go the SNF to take photographs of the building and verify it is operational to ...
PDF DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid
This article describes two new processes that CMS now employs as part of the provider enrollment process: (1) Automated provider screening, and (2) implementation of a new national site visit contractor that will conduct site visits to certain providers and suppliers. This NFPP is intended to protect the Medicare Program and to ensure that ...
4 Common Mistakes Not to Make During CMS Medicare Verification Site
Practices and businesses who wish to be enrolled as Medicare providers or suppliers must submit to a site visit as part of the provider enrollment or verification process.The Centers of Medicare & Medicaid Services (CMS) use the information obtained during a site visit to verify that your business is legitimate, and that the information submitted to CMS systems for Medicare enrollment is accurate.
PDF Medicare Provider Enrollment Compliance Conference
initial enrollment, revalidation, adding a new location CMS has the authority to perform site visits on all providers. address validation errors, CAPs/reconsiderations, provider enrollment initiatives. Verifies practice location information to determine compliance with enrollment requirements and supplier standards (IDTF, DME)
Nursing Facility Medicare Provider Enrollment Verification Site ...
Nursing facility providers may receive site visits from the National Site Visit Contractor (NSVC) on behalf of the Centers for Medicare and Medicaid Services (CMS). The NSVC may take pictures of the building to verify practice location and structure to determine compliance with Medicare enrollment and other requirements (42 CFR §424.518).
PDF Information and Updates from NSC
during your enrollment period with Medicare to verify and validate compliance with the Medicare supplier standards. There are two types of site visits that a supplier may receive: regular site visit and the shorter observational site visit. In both instances, the inspector will be National Supplier Clearinghouse employee a or authorized contractor.
Medicare Enrollment Guide for Institutional Providers
Medicare Administrative Contractors (MACs) process all Medicare applications for institutional providers. After you submit your enrollment application, your MAC will forward your application to the State Agency for the next step in the process. ... Your MAC may order a site visit from the National Site Visit Contractor before a final decision ...
Nursing Facility Medicare Provider Enrollment Verification Site Visits
Nursing facility providers may receive site visits from the National Site Visit Contractor (NSVC) on behalf of the Centers for Medicare and Medicaid Services (CMS). The NSVC may take pictures of the building to verify practice location and structure to determine compliance with Medicare enrollment and other requirements (42 CFR §424.518).
PDF DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid
In 2011, CMS implemented a site visit verification program using a National Site Visit Contractor (NSVC). The site visit verification program is a screening mechanism to prevent questionable providers and suppliers from enrolling or maintaining enrollment in the Medicare program. The NSVC will conduct unannounced site visits for Medicare Part A/B
MLN9658742
CMS conducts a site visit verification process using a National Site Visit Contractor (NSVC). A site visit helps prevent questionable providers and suppliers from enrolling or staying enrolled in the Medicare Program. The NSVC conducts unannounced site visits for all Medicare Part A and B providers and suppliers, including DMEPOS suppliers.
Review Contractor Directory
Part A and Part B Medicare Administrative Contractors (A/B MACS) Jurisdiction 5: Wisconsin Physicians WPS Medicare Part A Medical Review P.O. Box 8310 Omaha, NE 68108-0310 Accepts esMD transactions. Part A and Part B Medicare Administrative Contractor (A/B MAC) Jurisdiction 15 Home Health and Hospital Services CGS Administrators, LLC
PDF CMS Manual System Department of Health & Human Services (DHHS) (CMS
7763.1, the contractor shall not convey Medicare billing privileges to the supplier prior to the completion of the National Site Visit Contractor's (NSVC) site visit and the contractor's review of the results. X X 7763.2 If an ambulance supplier, ICL, IDTF, physical therapist or physical therapist group submits a