Provider Enrollment Resources:

• Enroll, change your Medicare information, and add or delete group members or locations online: https://pecos.cms.hhs.gov (print, sign and date the two-page Certification Statement and mail the Certification Statement and all supporting paper documentation to Palmetto GBA within seven days of electronic submission)
• Access CMS-855 forms (then print, sign and mail to Palmetto GBA)
• Palmetto GBA mailing addresses
• Access the status of your CMS-855 application
• Guidance on which form to complete
• Contact Palmetto GBA at (888) 828-2092 for additional assistance