Resources for Medicare Enrollment and National Provider Identifiers

Resources for Medicare Enrollment and National Provider Identifiers

Click below for information on provider enrollment, PECOS, NPI Basics, and links to Medicare forms

Provider Enrollment Update
CMS has added a report containing the names of physicians with pending Provider Enrollment, Chain, and Ownership System (PECOS) applications. You may check this report to find out if your Medicare contractor is still processing your PECOS application. CMS plans to update this report twice a week. CMS has also provided enrollment guidance  for physicians who infrequently receive payments from Medicare.

Provider Participation in the Medicare Program
Provides an overview of participation status options for providers in the Medicare program.

Internet Based Provider Enrollment, Chain and Enrollment System (Internet PECOS)
Provides a summary of the Internet PECOS 

Internet Based PECOS-Getting Started
Provides instructions on creating or updating your enrollment record in PECOS. 

Do you have an Enrollment Record in PECOS that contains your NPI?
Regarding Change Requests 6417 and 6421,  CMS has made available a file that contains the National Provider Identifier (NPI) and the first and last names of all physicians and non-physician practitioners who are eligible to order and refer (in the Medicare program) and who have current enrollment records in Medicare (i.e., they have enrollment records in Internet-based Provider Enrollment, Chain and Ownership System (PECOS) that contain an NPI). You can check this file to ensure that you are enrolled in PECOS and enroll in PECOs if you aren’t. 

Change in Provider Enrollment Timeliness Standards for Certain Paper Applications
Effective June 21, 2010 Medicare will change the timeliness standards for provider enrollment processing for the CMS-855I and 855B initial applications, change requests and reassignments.

NPI Basics
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA.

Viewing, Accessing or Maintaining your NPPES Account Information
CMS recommends that health care providers that have obtained their NPI know and maintain National Plan and Provider Enumeration System (NPPES) User Ids and passwords, reset NPPES passwords at least once a year and review NPPES records to ensure the accuracy of the information.

NPI Registry
The NPI Registry enables you to search for a provider's NPPES information. All information produced by the NPI Registry is provided in accordance with the NPPES Data Dissemination Notice. You may run simple queries to retrieve this read-only data. For example, users may search for a provider by the NPI or Legal Business Name. There is no charge to use the NPI Registry.

Medicare Forms
Medicare Provider Enrollment forms, Provider Participation Application forms, Appeal forms, and Advance Beneficiary Notice Forms.

Page Last Updated: August 3, 2012