Medicare PECOS Enrollment: Step-by-Step for Physicians

Medicare PECOS Enrollment Steps

  1. Verify NPI is correct — Check NPPES.CMS.HHS.gov; address must match practice location
  2. Complete CAQH ProView — Medicare queries CAQH for credential verification
  3. Identify your MAC — Each state has a Medicare Administrative Contractor that processes enrollment
  4. Complete CMS-855I — Individual practitioner enrollment form
  5. Complete CMS-855B — Group/organizational enrollment (if billing under group NPI)
  6. Complete CMS-855R — Reassignment of benefits from individual to group NPI
  7. Submit EFT authorization — Required for Medicare electronic payments
  8. Track in PECOS portal — Application status updates available online
  9. Receive PTAN — Provider Transaction Access Number issued upon approval

Related: Medicare enrollment services | Medicare checklist tool.

Before You Start: The Prerequisites

Three things must be correct before any PECOS submission: your NPPES record (address, taxonomy, and practice info current — PECOS validates against it), your supporting documents scanned and ready (license, board cert, malpractice face sheet, IRS documentation for groups), and your MAC identified (Novitas, Noridian, Palmetto, CGS, NGS, WPS, or First Coast depending on state — applications to the wrong MAC bounce weeks later).

After Submission: Managing the MAC

Your application enters the MAC's development queue, where analysts review and issue development requests for anything unclear — these arrive by mail and PECOS portal message with roughly 30-day response windows. Check the portal weekly; a missed development request means rejection and restart. Upon approval you receive your PTAN (Provider Transaction Access Number) — but don't bill yet: confirm your effective date, verify EFT is active, and load the PTAN into your billing system. Retroactive billing is allowed up to 30 days before your application receipt date in most cases — know your exact date before submitting claims. Full Medicare enrollment service | Medicare checklist | revalidation tracking.