7 steps to getting enrolled through PECOS
PECOS is the CMS portal where Medicare enrollment applications are submitted, tracked, and managed. Here's how to get through it in seven steps.
Step 1: Apply for your NPI
Every provider and organization that bills Medicare needs a National Provider Identifier (NPI). Type 1 NPIs are for individuals. Type 2 NPIs are for organizations. Sole owners of a single-shareholder PC need both.
Apply through NPPES, the National Plan and Provider Enumeration System. Industry sources put clean electronic NPI applications at as little as 10 business days, with paper applications taking around 20 business days. Errors at this stage push the timeline out further.
Two details catch first-time applicants:
- The legal name and address on the NPI must match the IRS CP-575 letter precisely. Even a missing suffix triggers downstream rejections.
- An NPI is required before any other step in this guide.
Step 2: Set up your CMS Identity & Access (I&A) account
PECOS sits behind the CMS Identity & Access Management system. Before opening a PECOS application, the provider or an authorized official needs an active I&A account. Account setup typically takes 1 to 3 days when documentation is in order and requires:
- A valid email address with multi-factor authentication enrolled
- Role designation (provider, authorized official, delegated official, or surrogate)
- Identity verification through the I&A system
Once the I&A account is active, request access to PECOS through the CMS portal. Group practices typically designate an authorized official to manage submissions for the entity, with delegated officials handling day-to-day work.
Step 3: Select the right CMS-855 form
The CMS-855 form depends on what's being enrolled:
| Form | Who files it |
|---|---|
| CMS-855I | Individual physicians, NPPs, sole proprietors of single-shareholder PCs |
| CMS-855B | Clinics, group practices, organizational suppliers (other than DMEPOS) |
| CMS-855A | Institutional providers: hospitals, HHAs, hospices, SNFs |
| CMS-855O | Physicians and NPPs who only order or certify, not bill |
| CMS-855S | DMEPOS suppliers |
| CMS-20134 | Medicare Diabetes Prevention Program (MDPP) suppliers |
Important to note: CMS has discontinued the standalone CMS-855R (reassignment of benefits). All paper reassignment actions are now reported on the CMS-855I in Section 4F. In Internet-based PECOS, reassignments are still completed through the reassignment workflow, with the same data captured under the 855I record.
Step 4: Gather supporting documents
Every CMS-855 submission needs the same core packet:
- Active state medical license for every state the provider practices in (telehealth providers need a license in the state where the patient is located during the visit)
- DEA certificate, if prescribing controlled substances
- Malpractice insurance certificate showing carrier, coverage amounts, and effective dates
- IRS CP-575 or Letter 147C confirming the legal business name and EIN
- W-9 for the billing entity
- Voided check or bank letter matching the legal business name exactly (submitted with the CMS-588 EFT authorization to verify routing and account information)
- CV with complete work history, gaps over six months explained
- Education and training records: medical school, residency, fellowship
- Board certifications, if applicable
- Disclosure of any adverse legal actions
Two companion forms accompany every submission:
- CMS-588 (Electronic Funds Transfer authorization) is required because Medicare pays only by EFT.
- CMS-460 (Participation Agreement) is optional but elects participating status, which typically results in higher reimbursement and direct payment.
Most rejections trace back to name mismatches across the application, the IRS record, and the bank documentation. Verify every detail matches exactly before submission.
Step 5: Complete and submit the application in PECOS
Inside PECOS, the system walks the applicant through the relevant 855 sections based on provider type. PECOS 2.0 redesigned the workflow with pre-populated data, multi-enrollment management, and a real-time status tracker.
A few practical pointers:
- Save progress frequently. PECOS sessions can time out and lose unsaved data.
- Upload supporting documents directly in PECOS rather than mailing them separately. Paper attachments add weeks to processing.
- Have the authorized or delegated official electronically sign before submission. Unsigned applications are returned automatically.
After submission, PECOS issues a confirmation and a tracking number. The application then routes to the assigned Medicare Administrative Contractor (MAC) for review.
Step 6: Pay the application fee (if required)
The 2026 Medicare enrollment fee is $750, adjusted annually by the percentage change in the Consumer Price Index for All Urban Consumers (CPI-U) for the 12 months ending June 30, per 42 CFR § 424.514(d)(2).
The fee applies in three scenarios: initial enrollment, revalidation, and adding a new Medicare practice location. The fee-paying provider and supplier types are:
- Institutional providers filing the CMS-855A, including hospitals, critical access hospitals, skilled nursing facilities, hospices, home health agencies, FQHCs, rural health clinics, ESRD facilities, and CORFs
- Part B suppliers filing the CMS-855B that aren't physician or non-physician practitioner (NPP) organizations, including ambulatory surgical centers, ambulance suppliers, independent diagnostic testing facilities (IDTFs), independent clinical labs, portable X-ray suppliers, mammography centers, hospital departments, and PT/OT groups in private practice
- DMEPOS suppliers filing the CMS-855S
- Opioid treatment programs, which file under either the CMS-855A or CMS-855B depending on structure
Per 42 CFR 424.502 and 42 CFR 424.514, the key nuance for Part B filers is that physician and NPP group practices don't pay the fee, but an 855B filer that isn't physician/NPP based (an IDTF, ambulance service, or independent lab) does.
Physicians, NPPs, physician organizations, and MDPP suppliers are exempt. Pay during the PECOS application flow or through pay.gov for paper filers.
Providers can request a hardship exception to the application fee by submitting a written request with supporting documentation describing the financial hardship alongside the application. CMS reviews these case by case. Until CMS approves or denies the request, the MAC won't begin processing; factor in that wait.
Step 7: Wait for MAC processing
A clean PECOS web submission is typically processed in 15 to 30 days, with CMS setting a goal of 15 days for 95% of internet-based applications without site visits. Palmetto GBA reports averaging 7 days for accurate submissions, while NGS targets 15 days. Paper applications take roughly 30 days under CMS standards, or up to 65 days when a site visit is required.
Real-world timelines vary by MAC (Novitas, Palmetto, Noridian, WPS, and others) and can stretch to 90-180 days when applications are incomplete or trigger additional review.
Site visits are tied to the screening level under 42 CFR 424.518. Newly enrolling home health agencies and DMEPOS suppliers are designated high risk and get an on-site visit plus fingerprinting. Hospices, SNFs, FQHCs, RHCs, ASCs, ambulance suppliers, IDTFs, and certain other moderate-risk categories get an on-site visit only.
Hospitals, CAHs, and physician or NPP organizations are limited risk and don't require a site visit. A site visit can add several weeks to processing.
If the MAC requests additional documentation, the applicant has 30 days to respond. Miss it, and the application is rejected. Resubmission adds another 60 to 90 days to the timeline.
Physicians, NPPs, physician/NPP organizations, ambulance suppliers, and opioid treatment programs can retroactively bill up to 30 days before their effective date under 42 CFR § 424.521 (90 days during a Presidentially declared disaster).
Institutional providers and most 855B suppliers get no look-back: billing privileges start on the filing date or first service date, whichever is later. Submit before the start date.
What happens after approval
Approval isn't the end of Medicare credentialing. CMS requires ongoing compliance:
- Revalidation every five years, or every three years for DMEPOS suppliers. The MAC sends notice three to four months (approximately 90 to 120 days) before the due date.
- 30-day reporting of ownership or control changes, practice location changes, and final adverse legal actions, per 42 CFR § 424.516.
- 90-day reporting of all other enrollment changes.
Missing a revalidation deadline results in deactivation with no retroactive payment recovery for services delivered during the lapse.
Where automation fits in Medicare credentialing
PECOS submission remains a human task. The system has identity verification and IP-tracking constraints that don't lend themselves to generic automation. The credentialing work around PECOS is a different story.
Once a provider is enrolled in Medicare, the same documents are resubmitted to CAQH, commercial payers like United and Aetna, and the Medicare Advantage plans those insurers operate, each on its own schedule.
We built Kaizen for that multi-payer credentialing and maintenance work, where the same browser actions repeat across dozens of portals. Book a call and see how that workflow runs automatically in days.
Frequently asked questions
Is PECOS the same as Medicare credentialing?
No, PECOS isn't the same as Medicare credentialing. PECOS is the online system CMS uses to process applications, while Medicare credentialing is the underlying enrollment process that includes the CMS-855, CMS-588, and supporting documents.
Do you need an NPI before applying for Medicare credentialing?
Yes, every provider needs an NPI before starting Medicare credentialing. Apply through NPPES, the National Plan and Provider Enumeration System, which typically issues NPIs within a few business days.
How much does Medicare credentialing cost in 2026?
The 2026 Medicare enrollment application fee is $750 for institutional providers, DMEPOS suppliers, opioid treatment programs, and new institutional practice locations. Physicians, NPPs, physician organizations, and MDPP suppliers are exempt.
