Last Modified: 5/4/2020
Location: FL, PR, USVI
Business: Part A, Part B
Q: How do I know which provider enrollment application to use?
You may either use the Provider Enrollment, Chain, and Ownership System (PECOS)
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
The direct link for each Medicare provider/supplier enrollment application is shown below:
• Clinics/group practices and certain other suppliers: CMS-855B • Physicians and non-physician practitioners (including clinical psychologists): CMS-855I • Ordering, certifying and prescribing providers: CMS-855O Note:
Ordering/referring providers must meet the criteria specified by SE 1305
• Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers: CMS-855S Note: CGS Medicare
is the DMEPOS Medicare Administrative Contractor (MAC) for Florida, Puerto Rico, and the U.S. Virgin Islands.
Note: The Centers for Medicare & Medicaid Services approved two new enrollment forms, CMS-855C and CMS-855POH. For more information, access the change request (CR) 9120
and the CMS Forms List
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First Coast Service Options (First Coast) 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.