What is Medicare provider enrollment?
Medicare provider enrollment is the process by which providers and suppliers apply for and maintain participation in Medicare so they can bill for covered services. CMS manages it through PECOS: providers file CMS-855 applications to enroll, revalidate, or update records, and receive a PTAN from their Medicare Administrative Contractor. CMS can deny or revoke enrollment for cause.
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- CMS PECOS — provider enrollment
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Full name: Medicare Provider Enrollment
Short explanation
Provider enrollment is the process by which health care providers and suppliers apply for and maintain participation in Medicare, Medicaid, or other federal health care programs. CMS manages Medicare enrollment through PECOS. Providers submit CMS-855 forms (or online equivalents) to apply, revalidate, or update enrollment records. Enrolled providers receive a PTAN from their Medicare Administrative Contractor. CMS may revoke, deny, or bar enrollment for fraud, OIG exclusion, or failure to meet program standards.
How it’s used
- CMS PECOS Medicare Provider Enrollment: PECOS is the CMS system for all Medicare provider enrollment actions — applications, revalidations, changes, and revocations.
- OIG LEIE (oig-leie): OIG exclusions trigger mandatory revocation of Medicare enrollment — cross-referencing LEIE against PECOS records is a compliance requirement.
Frequently asked questions
- What is Medicare provider enrollment?
- Provider enrollment is the process of applying to CMS to participate in Medicare and receive Medicare reimbursement for covered services.
- How do providers enroll in Medicare?
- Providers submit CMS-855 enrollment applications through PECOS (online) or by paper form to their Medicare Administrative Contractor (MAC).
- What happens if a provider fails to revalidate enrollment?
- CMS may revoke Medicare billing privileges if a provider misses a revalidation deadline. Providers typically have a 90-day window to reactivate.