Five Steps to PECOS Enrollment

March 28, 2013

How to Enroll in PECOS:

___ Get your National Plan and Provider Enumeration System (NPPES) user ID and password. (if you don’t have a NPPES login, or need help changing your password, contact the NPI Enumerator at: 1.800.465.3203 or customerservice@npienumerator.com).

___ Gather the necessary items for enrollment. (See “Before You Enroll” checklist below.)

___ Complete and submit the enrollment application at: https://pecos.cms.hhs.gov.

___ Print, sign, and date the two-page Certification Statement. (Available at the end of the online application.)

___ Mail the signed Certification Statement, along with supporting documentation, to your designated Medicare contractor within seven days of the electronic submission.

For more information, please visit www.cms.gov

For Help and Troubleshooting:

If you have PECOS Web navigation and access issues, contact the EUS Help Desk at 866.484.8049 or at EUSSuport@cgi.com.

For Provider Enrollment Information:

Contact the Medicare contractor for your state. Visit www.cms.gov/MedicareProviderSupEnroll to download a list of contractors by state.

Before you enroll:

Save time by gathering items on this checklist before you enroll:

___ National Provider Identifier (NPI)

___ NPPES IS & Password

___ Personal Identifying Information:

Legal name

Date of birth

Social Security Number

___ Schooling information:

School name

Graduation year

___ Professional License information:

Medical license number

Original effective date

Renewal date

State where issued

___ Certification information:

Certification number

Original effective date

Renewal date

State where issued

___ Specialty/Secondary Specialty Information

___ Drug Enforcement Agency (DEA) Number

___ Information About Final Adverse Actions (if applicable)

___ Practice Location Information

Medical practice location

Special payment information

Medical record storage information

Billing agency information (if applicable)

Any federal, state, and/or local professional licenses, certification and/or registrations required for practice

___ Electronic Funds Transfer Information Documentation

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