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First Coast Service Options Inc.
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Last Modified: 10/9/2011 Location: FL, PR, USVI Business: Part A, Part B

Provider enrollment application types FAQ

Q: How do I know which provider enrollment application to use?
A: You may either use the Provider Enrollment Chain and Ownership System (PECOS) external link to enroll online or mail a paper application form. PECOS supports the Medicare provider and supplier enrollment process by capturing provider/supplier information from the CMS-855 family of forms. The system manages, tracks, and validates enrollment data collected in both paper form and electronically via the Internet. To find out more about PECOS, please refer to the PECOS FAQs external link located on the PECOS website.
The direct link for each Medicare provider/supplier enrollment application is shown below:
Institutional providers: CMS-855A external link to pdf
Clinics/group practices and certain other suppliers: CMS-855B external link to pdf
Physicians and non-physician practitioners (including clinical psychologists): CMS-855I external link to pdf
Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers: CMS-855S external link to pdf
Reassignment of benefits: CMS-855R external link to pdf
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First Coast Service Options (FCSO) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.