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Video instructions and help with filling out and completing palmetto gba form 855a
This video explains the Medicare enrollment process and how to use the provider enrollment chain and ownership system or Pecos the online system to submit a Medicare enrollment application before you begin the application in Pecos gather the following information active national provider identifier or NPI number if you do not already have an active NPI number you can register for one through the national plan and provider enumeration system or n Pez their website is nppes CMS HHS gov personally identifying information including your legal name date of birth and social security number on file with the Social Security Administration educational information including the name of your medical or professional school and graduation year medical specialty information including specialty type for example dentist or nurse practitioner professional license certification and/or drug enforcement agency or DEA registration numbers be sure you have the original effective dates renewal dates and the state or states where the license certification and/or DEA registration number was issued correspondence address information regarding any final adverse legal actions for example probation or suspension of a license past revocation for Medicare or felony conviction once you have the information and the supporting documentation gathered log into Pecos at Pecos CMS HHS gov with the same user ID and password used to access the n PES website or the Identity and Access Management System if you don't know your user ID and/or password select the forgot password or forgot user ID link if you don't have an account or are an authorized surrogate submitting the application on behalf of a prescriber and need to establish one select the register for a user account option there are video tutorials available at nppes CMS HHS gov /ia web /login do with more information on account creation after logging in click my enrollments next click new application to start the application process Pecos asks a series of questions to identify the enrollment action you are attempting to take and the correct enrollment application if you are a provider enrolling for the sole purpose of prescribing Part D drugs who will not build Medicare for services select yes when asked if you are enrolling solely to order and refer items and services CMS is updating the language on the screen to also reference prescribers note prescribing pharmacists do not need to enroll in Medicare to have their Part D prescriptions covered select the state or territory where you practice next indicate your specialty if none of the options apply to you or you are a dentist in rolling as a Part D prescriber select undefined physician type and enter your specialty in the space provided if your specialty is not listed and you are unsure if you are permitted to enroll contact your Medicare administrative contractor or Mac you can find the Mac that serves your location on the prescriber enrollment website at godot CMS gov forward slash prescriber enrollment once you have entered your personal information review your entries and.