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Auxilary Aids & Services

For information about the availability of auxiliary aids and services, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html

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Jurisdiction 11 Part B
Sign Your Medicare Enrollment Application Electronically

Internet-based PECOS (Provider Enrollment, Chain and Ownership System) now allows providers to sign Medicare enrollment applications electronically. Save time and expedite review of your application by using Internet-based PECOS. This feature does not change who is required to sign the application.

Any Organizational Provider applications that are submitted via internet-based PECOS will require the user completing the application to provide an email address for the authorized signer of the application as part of the submission process. The authorized signer can then follow the instructions in the email and electronically sign the application. This applies to applications using the following forms:

  • 855-A for Institutional Providers
  • 855-B for Clinics, Group Practices, and Certain Other Suppliers
  • 855-S for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Suppliers

In Internet-based PECOS, all Individual Provider applications submitted by the individual provider that do not include new reassignments may be e-signed as part of the submission process. This applies to applications using the following forms:

  • 855-I for Physicians and Non-Physician Practitioners
  • 855-O for Eligible Ordering and Referring Physicians and Non-physician Practitioners

Any Individual Provider application (855-I) containing new reassignments (855-R) can be electronically signed as part of the submission process; however, you must select the Authorized Official/Delegated Official (AO/DO) for the Organization that is accepting the reassignment and enter that official’s email address. The official then will be required to follow the instruction in the email and electronically sign the application.

If an individual provider or AO/DO does not want to make use of the e-signature process, they can simply follow the current process of printing and signing the certification statement (which then needs to be mailed to the appropriate contractor).

Questions concerning a system issue regarding PECOS should be referred to the CMS EUS Help Desk at 866-484-8049 or EUSSupport@cgi.com.


 

last updated on 04/30/2012
ver 1.0.51