Ordering/Referring Provider Only

Ordering/Referring Provider Only Download CMS-855O. Complete sections 1, 2, 3, 4, 5, 6 and 8. Note: Ordering and referring providers are only required to be enrolled in one state. Be sure to include supporting documentation for [...]

Adding a New Reassignment of Benefits Using the CMS-855I

Adding a New Reassignment of Benefits Using the CMS-855I Download CMS-855I version (5/23): Complete sections 1A and B, 2A, 3, 4F (add, terminate, change reassignment), 13, and 15B and 15C IMPORTANT: If an individual is new to the [...]

Electronic Funds Transfer Agreement

Electronic Funds Transfer Agreement Download and complete the CMS-588 EFT Authorization Agreement. Physicians and nonphysician practitioners who are reassigning all of their payments to another entity are not required to submit the CMS-588. [...]

Medicare Participating Physician or Supplier Agreement

Medicare Participating Physician or Supplier Agreement Download and complete CMS-460 Medicare Participating Physician or Supplier Agreement. Note: CMS-460 must have a signature and date of participant or authorized representative of [...]

1-800-MEDICARE Authorization to Disclose Personal Health Information

Prior Authorization Request for Outpatient Services: Implanted Spinal Neurostimulators

Prior Authorization Request for Outpatient Services: Cervical Fusion

Creating application in PECOS

Creating Application in PECOS Instructions to create an application in PECOS: Login to PECOS My Associates Create Initial Enrollment Application Note: There will be a series of questions to determine application descriptions tailored to [...]

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 18th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 18th Sessions! Our third in the series of Medicare Part B 2024 Spring/Summer Virtual Conference Tuesday’s [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: CustomerService-DoNotReply@cms.hhs.gov containing the PECOS web tracking number. [...]