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 (PDF, 772 KB)
• 855-B for Clinics, Group Practices, and Certain Other Suppliers (PDF, 661 KB)
• 855-S for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Suppliers (PDF, 612 KB) 

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 (PDF, 523 KB) 
• 855-O for Eligible Ordering and Referring Physicians and Non-physician Practitioners (PDF, 234 KB)

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 must upload the certification statement via PECOS upload functionality. Contractors cannot accept mailed paper certification statements.

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