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Provider Enrollment
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 the Provider Enrollment Support Line at (866) 308-5439 for additional assistance
Provider Enrollment
855 Application
General
Provider Enrollment: Revalidation Cycle
11/20/2009
2010 Annual Participation Enrollment Program Extension
11/18/2009
One-Time Mailing of Supplier Responsibilities Letter: Individual Practitioners Only
10/07/2009
Medicare Enrollment: Reporting Changes to Information
08/10/2009
Online Medicare Enrollment: Internet-based PECOS
08/10/2009
Provider Enrollment Applications: Online Status
08/10/2009
Enrollment Terminology
08/07/2009
Guidance on Using Internet-based Provider Enrollment, Chain and Ownership System (PECOS)
08/05/2009
Medicare Billing Privileges: Revisions to Certain Items in CMS Change Request 6310
07/02/2009
Discontinuance of Unique Physician Identification Number (UPIN) Registry
06/03/2009
Requirements for Specialty Codes
05/08/2009
Medicare Participating Physicians Directory (MEDPARD)
04/14/2009
Participation Agreement Form and Instructions
11/07/2008
Payment For Services Provided Under a Contractual Agreement
03/08/2008
Electronic Funds Transfer (EFT)
09/14/2007
New Provider Education Information Packet
03/08/2006
IDTF
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last updated on 11/20/2009