November 2023
Provider Enrollment
CGS processes web and paper applications submitted as initial enrollments and changes of information for providers in accordance with the CMS published guidelines.
Physicians, Non Physician Practitioners, and Groups can enroll or make changes to their enrollment information using either:
- The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or
- The paper enrollment application process (e.g., CMS-855I, CMS-855B).
There are three basic steps to completing an enrollment action using Internet-based PECOS. Physicians, Non Physician Practitioners, and Groups/Organizations must:
- Have a National Plan and Provider Enumeration System (NPPES) User ID and password to use Internet-based PECOS.
- For security reasons, passwords should be changed periodically, at least once a year.
- For information on how to change a password, go to the NPPES Application Help page available at https://nppes.cms.hhs.gov/NPPES/Welcome.do
and select the "Reset Password Page" on the NPPES Application Help page.
- Go to PECOS at https://pecos.cms.hhs.gov to complete, review, and submit the electronic enrollment application via PECOS.
- Print, sign, and date the two-page Certification Statement and mail it with all supporting paper documentation with seven days of the electronic submission to:
J15 - Part B Provider Enrollment
CGS Administrators, LLC
PO Box 20017
Nashville, TN 37202
NOTE: The Internet enrollment application cannot be processed without the signed and dated two-page Certification Statement and the required supporting documentation. In addition, the effective date of filing an enrollment application is the date the Medicare contractor receives the signed two-page Certification Statement that is associated with the Internet submission.
Physicians, Non Physician Practitioners, and Groups/Organizations who are enrolled in the Medicare Program, but have a CMS -855 since 2003, are required to submit a Medicare enrollment application (i.e., Internet-based PECOS or the CMS-855) as an initial application when reporting a change for the first time.
For additional information regarding the Medicare enrollment process, including Internet-based PECOS, go to https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/index.html on the CMS website.
Enrollment Requirements:
- Provider Enrollment Applications were updated July 2009. To obtain the most current versions of the CMS-855 applications, please access the CMS website at : https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/index.html.
- To apply or make changes to your current enrollment using the Internet-based PECOS, go to https://pecos.cms.hhs.gov.
- All new enrollments or changes to existing provider information must include the individual National Provider Identifier (NPI) in the designated sections of the application. To apply for an NPI or correct information on file with NPPES, you can access the NPI application form at: https://nppes.cms.hhs.gov/NPPES/Welcome.do. If you need additional information regarding the NPI you may contact the enumerator company (Fox Systems) directly by calling 1.800.465.3203, or e-mail them at: customerservice@npienumerator.com.
- At the time of initial enrollment an Electronic Funds Transfer Authorization Agreement (CMS-588) must be submitted. Providers already enrolled that are not established for electronic payments must also submit an Electronic Funds Transfer Authorization Agreement when submitting an application to update or change information. The CMS-588 form can be downloaded at: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/index.html
- If a provider wants to enroll as a participating provider (PAR), the Participation Provider Agreement (CMS-460) should be included with the enrollment application. The provider has up to 90 days after enrollment to submit a PAR Agreement. The most current PAR Agreement is included on this CD.
Provider Enrollment questions should be made to the applicable customer service jurisdiction telephone number and during the specified time.
- Kentucky and Ohio 866.276.9558
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