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Medicare Enrollment Application - Clinics/Group Practices and Certain Other Suppliers
Clinics, group practices, and other suppliers can apply for enrollment in the Medicare program or make a change in their enrollment information using either: The Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or. The paper CMS-855B enrollment application.
Clinics and group practices can apply for enrollment in the Medicare program or make a change in their enrollment information using either: •The Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or •The paper enrollment application process (e.g., CMS 855B).
Clinics and group practices can apply for enrollment in the Medicare program or make a change to their existing information using the Clinics/Group Practices and Other Suppliers (CMS-855 B) application.
PECOS supports the Medicare Provider and Supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information. New to PECOS? View our videos at the bottom of this page.
The Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) can be used in lieu of the Medicare enrollment application (i.e., paper CMS-855) to: Submit an initial Medicare enrollment application. View or change your enrollment information. Track your enrollment application through the web submission process.
Internet-based PECOS - supports the Medicare Provider and Supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information; CMS 855B--Medicare Enrollment Application for Clinics, Group Practices, and Certain Other Suppliers
The following forms can be used for initial enrollment, revalidations, changes in status, and voluntary termination: CMS-855A (PDF) for Institutional Providers. CMS-855B (PDF) for Clinics, Group Practices, and Certain Other Suppliers.
What is the 855B? The CMS form used for the enrollment of Clinic/Group practices and Certain Other Suppliers. This form is also used to submit changes to your enrollment data. Benefits of using PECOS vs. Paper. We encourage you to use PECOS instead of paper Medicare enrollment applications. Advantages of using PECOS include:
CMS-855B ‒ Medicare Enrollment Application for clinical/group practices. This form is used to initially enroll, revalidate or make change(s) to the existing Medicare enrollment information for clinic or groups.