Information required for PECOS enrollment submission
What information will I need before I begin to complete my
enrollment via Internet-based PECOS?
below is a list of the types of information needed to
complete an initial enrollment action using Internet-based PECOS. This
information is similar to the information needed to complete a paper Medicare
enrollment application.
* An active National Provider Identifier
(NPI).
* National Plan and Provider Enumeration
System (NPPES) User ID and password.
* Personal identifying information. This
includes legal name on file with the Social Security Administration, date of
birth, Social Security Number
* Professional license and certification
information. This includes information regarding the physician's or non-physician
practitioner's professional license, professional school degrees or
certificates.
* Practice location information. This
information includes information regarding the practitioner's medical practice
location, the legal business name of a solely-owned Professional Association,
Professional Corporation, or Limited Liability Company (LLC) on file with the
Internal Revenue Service and appearing on the IRS CP575, and any Federal,
State, and/or local (city/county) business licenses, certifications and/or
registrations specifically required to operate as a health care facility.
* If applicable, information regarding any
final adverse actions. A final adverse action includes: (1) a Medicare-imposed
revocation of any Medicare billing privileges; (2) suspension or revocation of
a license to provide health care by any State licensing authority; (3)
revocation or suspension by an accreditation organization; (4) a conviction of
a Federal or State felony offense (as defined in 42 CFR 424.535(a)(3)(A)(i))
within the last ten years preceding enrollment, revalidation, or re-enrollment;
or (5) an exclusion or debarment from participation in a Federal or State
health care program.
Note: Some physicians and non-physician practitioners may
find it useful to print and review the CMS-855I paper enrollment application
before initiating an Internet-based PECOS enrollment action.
No comments:
Post a Comment