Last Modified: 6/19/2018 Location: FL, PR, USVI Business: Part A, Part B
Clinical psychologist -- enrollment application
Q: I am a clinical psychologist. Do I need to complete a special Medicare enrollment application?
A: If you are a clinical psychologist or a psychologist who bills independently, you have two options:
• Use the Provider Enrollment, Chain, and Ownership System (PECOS) to enroll online.
Note: 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.
• Complete and mail the Physicians and non-physician practitioners enrollment application form: CMS-855I .
Note: Community mental health centers should use the enrollment application form for institutional providers: CMS-855A .
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