Credentialing for Medicare

PECOS Medicare Enrollment: 

Before we get into the process of enrolling in Medicare using PECOS, we want to provide with you a few tips and answer some frequently asked questions.

Improve the processing time of your application by ensuring the application is complete and accurate prior to submitting.  Seems easy enough, but there’s this idea out there that you should just get your application in the pipeline even if you’re not sure about some things or if your application is inaccurate or subject to change.  Submitting erroneous information to speed up the processing can lead to severe delays and even fraud claims.

One item that is often overlooked or disregarded is the verification process CMS uses for your company.  The name on your IRS form CP575 or 147C must be identical to the name on your organization’s NPI application, business banking account and state’s Secretary of State website.  This is critical and your application will be rejected if there is an error here.

STEP 01: IDENTITY AND ACCESS MANAGEMENT-

The first step in setting up your enrollment record is to set up an account in Identity & Access Management System.  You will need an NPI in order to do this.  Your I&A account is what you will use to access PECOS.  If you do not have an NPI, start with NPPES and obtain an NPI.  Most providers in residency will already have an NPI so if you’re not sure, do a search on the NPI Registry to see if you’re listed.  If you are, you simply need to reset your login info using your personal info.

STEP 02 :LOGIN TO PECOS-

  1. Next you will want to log in to PECOS using your new information.  If you are setting up a new company, perhaps as the sole owner of a new LLC, you will need to obtain a type 2 NPI otherwise known as an Organizational Provider NPI.  You can apply for a type 2 NPI here: NPPES
  2. Upon logging in, you will see a button to apply for an NPI.  You will want to apply for a type 2 NPI if you already have your persona NPI. 
  3. Before you can apply for a type 2 NPI, you will need your company registered in your state and will need to have obtained your TAX ID from the IRS.  You can do that here: IRS Online EIN Request.

STEP 03: SUBMIT YOUR APPLICATION-

There are primarily four ways that you will be enrolling in PECOS which are as follows: 

  • Enrolling as an employee/contractor of an established Medicare Provider/Supplier
  • Enrolling as a provider and owner of a new Medicare supplier
  • Enrolling as an owner/managing investor of a new Medicare supplier
  • Enrolling as an individual of a sole proprietorship

NOTE:

  • Sole Proprietorships (even those with a tax id) should not apply for a type 2 NPI.  Type 2 NPIs are reserved for corporations and organizations registered in their state.
  • All of these applications can and should be submitted using PECOS.  You can submit paper applications which are linked below, but you can expect the paper enrollment process to take 90-120 days longer than an online PECOS application.

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