Medicare enrollment for providers: PECOS step by step
To enroll in Medicare as a provider, create an Identity & Access (I&A) account, then apply online in PECOS using the CMS-855I for yourself. Add the CMS-855B if you're setting up a group, reassign your benefits to it, and submit the CMS-588 for direct deposit. Your Medicare Administrative Contractor (MAC) reviews it, often in 30 to 60 days, and sends an approval letter with your PTAN.
- Get your NPI and create an I&A account
- Decide which forms you need: 855I, 855B, reassignment, 588
- Complete the application in PECOS and e-sign it
- Answer any MAC requests within 30 days
- Receive your approval letter, PTAN and effective date
- Bill from your effective date, and up to 30 days before it
Which Medicare forms you need
| Form | What it's for | Who files it |
|---|---|---|
| CMS-855I | Enrolls you as an individual physician or non-physician practitioner (NP, PA, CNS, therapist and others) | Every individual provider who bills Medicare |
| CMS-855B | Enrolls a clinic or group practice | Practices billing under a group NPI and Tax ID |
| CMS-855R | Reassigns your right to Medicare payment to a group | Providers in a group, unless you're its sole owner. Can be done in PECOS. |
| CMS-588 | Direct deposit (EFT) of Medicare payments | Whoever receives the payments. Required. |
| CMS-460 | Participation agreement, so you always accept Medicare's rate | Optional (see below) |
| CMS-855O | Lets you order or refer services without billing Medicare | Providers who never bill Medicare themselves |
Medicare is one of the first steps in getting credentialed with insurance companies, alongside Medicaid and your private insurers. A solo provider billing under their own name usually needs the 855I and 588. A new group practice with providers needs the 855B for the practice, an 855I for each provider, and a reassignment from each provider to the group.
Before you start
- NPI (and group NPI for a practice)
- I&A account for PECOS access
- State license, active where you practice
- Tax ID and legal business name
- Practice location address, exactly as on NPPES
- Bank account details for the CMS-588
- DEA registration, if you prescribe
- For groups: owners and managing employees
Physicians, non-physician practitioners and their group practices don't pay a Medicare application fee. The fee applies to institutional providers such as hospitals and suppliers.
Enrolling in PECOS, step by step
Step 1: Create your I&A account
PECOS uses the Identity & Access Management System for sign-in. Create your account, connect it to your NPI, and if a practice manager or credentialing service will work on your behalf, give them access through I&A rather than sharing your login.
Step 2: Complete the application
In PECOS, start a new initial enrollment. PECOS asks the same questions as the paper CMS-855 forms but only shows the sections that apply to you. Report your practice locations, where your records are kept, any adverse legal history and, for groups, ownership and managing control. Upload any documents it asks for, such as your license if your state can't be verified online.
Step 3: E-sign and submit
Sign electronically and submit. Online applications are processed faster than paper ones, and PECOS lets you track the status.
Step 4: Respond to your MAC
Your regional MAC reviews the application and may ask for corrections or more information. Answer within 30 days. If you don't, the MAC can reject the application, and you'll have to start again with a new receipt date.
Step 5: Approval and your PTAN
When you're approved, the MAC sends an approval letter with your Provider Transaction Access Number (PTAN) and your effective date. Keep it. You'll need the PTAN to use Medicare's online portals and for other enrollments, such as Medicare Advantage plans.
Your effective date and billing back 30 days
Your Medicare effective date is the later of two dates: the date your MAC received the application that was eventually approved, or the date you started seeing patients at that location. Once approved, you can bill for services you provided up to 30 days before your effective date.
How long Medicare enrollment takes
A clean online application is often processed in 30 to 60 days. Paper applications, applications that need corrections, and enrollments that need a site visit take longer. Each MAC publishes its current processing times on its website.
Participating or non-participating
When you enroll, you choose whether to sign the CMS-460 participation agreement.
- Participating: you accept Medicare's approved amount as payment in full on every claim. You're paid the full fee schedule and listed as participating in Medicare's directory.
- Non-participating: you can decide claim by claim whether to accept Medicare's rate. Your fee schedule is 95% of the participating rate, and when you don't accept assignment, you can't charge the patient more than Medicare's limiting charge.
Most practices choose to participate. Nurse practitioners and physician assistants enroll and bill under their own NPI and are generally paid 85% of the physician fee schedule.
After you're enrolled
- Report changes on time: a change of practice location, ownership or an adverse legal action within 30 days, and other changes within 90 days.
- Revalidate every 5 years, or sooner if your MAC asks. Medicare publishes due dates in advance. See how Medicare revalidation works.
- Join Medicare Advantage plans separately. Most Medicare patients choose plans run by private insurers such as UnitedHealthcare, Humana and Blue Cross plans. Each credentials you on its own, usually from your CAQH profile.
If you don't want to take Medicare
You can opt out instead of enrolling. Opted-out providers sign private contracts with Medicare patients, who then pay the full fee themselves, and Medicare pays nothing for those visits. An opt-out lasts two years and renews automatically unless you cancel it. It's a big decision for a new practice, because it rules out many patients over 65.
Want us to handle Medicare?
Our credentialing service prepares and submits your PECOS application, sets up reassignment and direct deposit, answers MAC requests, and sends you weekly updates until you have your PTAN. Medicare is included in our $900 full setup, or $150 on its own.
Start credentialingCommon questions
How long does Medicare enrollment take for providers?
A clean online application in PECOS is often processed in 30 to 60 days. Paper applications, applications that need corrections, and enrollments requiring a site visit take longer. Your Medicare Administrative Contractor publishes its current processing times.
Can I bill Medicare for patients I saw before I was enrolled?
Yes, within limits. Once approved, you can bill for services provided up to 30 days before your effective date. Your effective date is the later of the date your contractor received the approved application and the date you started at that location.
Which form do I use to enroll in Medicare?
Individual physicians and non-physician practitioners use the CMS-855I. Group practices use the CMS-855B, and providers reassign their benefits to the group with the CMS-855R or in PECOS. Everyone receiving payments also submits the CMS-588 for direct deposit.
Is there a fee to enroll in Medicare?
Not for physicians, non-physician practitioners or their group practices. The Medicare application fee applies to institutional providers, such as hospitals and certain suppliers.
Does enrolling in Medicare cover Medicare Advantage patients?
No. Medicare Advantage plans are run by private insurers, and each one credentials you separately, usually using your CAQH profile.