Home | Medicare Enrollment Services
Medicare Provider Enrollment: PECOS and CMS-855, Handled for You
Get Enrolled, Stay Enrolled and Get Paid by Medicare
Medicare will not pay a single claim until your enrollment is approved. Billing Benefit handles Medicare provider enrollment from start to finish: setting up PECOS access, choosing and completing the right CMS-855 application, answering requests from your Medicare Administrative Contractor (MAC), and keeping your enrollment current with revalidations and change reports. We can also enroll you in Texas Medicaid through TMHP and credential you with BCBS Texas and other commercial plans.
Which Medicare Enrollment Form Do You Need?
| Form | Who files it | Used for |
|---|---|---|
| CMS-855I | Individual physicians and non-physician practitioners such as NPs, PAs and therapists | New enrollment, revalidation and changes to your details |
| CMS-855B | Group practices, clinics and certain other suppliers, such as independent labs and ambulance companies | Enrolling the group so it can bill for the practitioners who work there |
| CMS-855A | Institutional providers such as hospitals, home health agencies, hospices and skilled nursing facilities | Enrollment, revalidation and changes of ownership |
| CMS-855O | Physicians and practitioners who only order or refer (for example labs, imaging or DME) and do not bill Medicare | Ordering and referring only |
| CMS-588 | Every enrolled provider and supplier | Electronic funds transfer (EFT), so Medicare payments go straight to your bank |
How Medicare Enrollment Works
From NPI to approval
Every provider needs a National Provider Identifier (NPI) first. We then set up your Identity & Access (I&A) account so we can work in PECOS for you as an approved surrogate, and file the right application online, which is usually faster than paper. Your MAC reviews it, may ask for more information, and then approves the enrollment and issues your PTAN. In Texas the MAC is Novitas Solutions (Jurisdiction H). If you are joining a group, we also link you to the group so Medicare pays the group for your services.
What We Handle for You
Less paperwork, fewer delays
We gather your licenses, board certifications, NPI, tax ID and practice location details, complete the application, upload the supporting documents and track it until it is approved. When the MAC sends a request for more information, you generally have 30 days to answer before the application can be rejected, so we respond quickly. We also set up EFT, check your effective date, and line up your commercial payer credentialing at the same time. Once you are enrolled, our medical billing team can start sending claims.
Effective Dates and Retroactive Billing
Know when you can start billing
For physicians and non-physician practitioners, the effective date is generally the later of the date the MAC receives an application it can process or the date you first saw patients at the new location. If circumstances kept you from enrolling sooner, Medicare allows billing for services up to 30 days before that date. A late or incomplete application can cost you weeks of unpaid visits, which is why we file as early as possible.
Revalidation and Keeping Your Enrollment Current
Do not let your billing privileges lapse
Medicare asks most providers and suppliers to revalidate every five years (every three years for DMEPOS suppliers). CMS posts due dates in advance, and missing one can lead to deactivation and a stop on payments. Changes must be reported too: for physicians and practitioners, a change of ownership, an adverse legal action or a new practice location within 30 days, and most other changes within 90 days. We track these dates and file the updates for you. Read our guide to provider enrollment, or contact us to get started.
Medicare Enrollment FAQs
How do I become a Medicare provider?
Get an NPI, then apply through PECOS (or on paper) with the CMS-855 form that fits you: CMS-855I for individual practitioners, CMS-855B for groups and clinics, and CMS-855R to reassign your payments to a group. Your Medicare Administrative Contractor (MAC) reviews the application and, once approved, issues your PTAN.
What is a PTAN?
A PTAN (Provider Transaction Access Number) is the Medicare number your MAC assigns after your enrollment is approved. You use it together with your NPI when working with Medicare.
How long does Medicare enrollment take?
It varies by MAC and application, and often takes several weeks. It takes longer when the MAC asks for more information. You generally have 30 days to respond to those requests, so we answer them quickly to keep the application moving.
How often do Medicare providers need to revalidate?
Most providers and suppliers revalidate every 5 years, and DMEPOS suppliers every 3 years. CMS publishes each provider’s due date, and a missed revalidation can stop your Medicare payments.
Can I bill Medicare for visits before my enrollment is approved?
Sometimes. Your effective date is generally the later of when you filed the application or when you started seeing patients at that location. Medicare also allows billing for services up to 30 days before that date if circumstances prevented earlier enrollment.
