Submit an Initial Enrollment Application

Table of Contents

• Step 1: Determine You are in the Right Place
• Step 2: Complete the Medicare Application
• Step 3: Submit the Required Documentation
• Related Content

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Step 1: Determine You are in the Right Place

The enrollment process for submitting an initial organization enrollment application has a number of steps as well as documents required for submission. You first need to know that you are in the right place.

To submit the initial organization enrollment application, you need to be at least one of the following:

• A health care organization and a new enrollee in Medicare
• Undergoing a change of ownership and not accepting assignment of the Medicare assets/liabilities of the former owner

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Step 2: Complete the Medicare Application

Once you are sure that this is the right enrollment for your business, you need to complete the correct applications for submission. The two applications for this initial enrollment process are the Medicare enrollment application forms CMS-855A and the CMS-588 (EFT)

Note: Read Understanding Authorized Official and Delegated Official Roles.

You can complete the enrollment application either electronically via Provider Enrollment Chain & Ownership System (PECOS) or on paper. Submitting the application electronically will result in a faster response than submitting by mail.

• To submit your application electronically, you will access PECOS. Here you will be able to become a registered user and gain access to the enrollment record to complete the electronic application. Select the My Associates button then select the Create Initial Enrollment Application button and the system will guide you through the process.
• To submit your application by mail, you will fill out CMS-855A as a new enrollee and CMS-588 (instructions for completion are on the forms). When completed, mail provider enrollment applications and supporting documents to appropriate jurisdiction and area address.
  • MAC Contact List

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Step 3: Submit the Required Documentation

It is imperative that you submit the proper documentation along with your enrollment application regarding your initial enrollment. Whether you chose to file electronically or on paper, you must prepare and submit documentation as follows:

• Online via PECOS: PECOS will generate a list of required supporting documentation that you upload (PDF or TIFF) prior to submitting the application.
• Paper Form CMS-855A: See section 17 of the CMS-855A application to determine the required documentation.

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Related Content

• Medicare Provider-Supplier Enrollment
• MLN Educational Tool – Medicare Provider Enrollment
• Tips to Facilitate the Medicare Enrollment Process

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