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What’stheformcalled?MedicareReconsiderationRequest(CMS)What’situsedfor?SignupopensinanewwindowSignupTheMACshalldevelopforthe otherformsTheCMSR(ReassignmentofMedicareBenefits)formhasbeendiscontinued.ElectronicallysignandsubmityourinformationFederaljurisdiction laboratoriesshouldcontacttheirCMSLocation(PDF)KeepacopyofyourcompletedMedicareenrollmentpackageforyourownrecordsTolocatethemailing addressforyourMedicareAdministrativeContractorfee-for-servicecontractor,goto:RequestanappealForadditionalinformationregardingtheMedicare enrollmentprocess(includingInternet-basedPECOS)andtogetthecurrentversionoftheCMSI,gotoapplyonlineatFormoreinformationaboutNPI enumeration,visitNOTE:TheLegalBusinessName(LBN)andaxIdentificationTNumber(TIN)thatyoufurnishinsection2AmustPrintyournameasshown onyourMedicarecard(LastName,FirstName,MiddleName)PECOSProviderInterface(PECOSPI)canbeusedtoPhysicians/non-physicianpractitioners mustobtainanNPIfromtheNationalPlanandProviderEnumerationSystem(NPPES)priortocompletingtheCMSIorCMSRenrollmentapplicationsbecause theNPImustbereportedontheapplications.Requestinganappeal(redetermination)ifyoudisagreewithMedicare’scoverageorpaymentision.1dayago Find codestobereimbursedforclinicalservicesIftheNPIisnotreported,theenrollmentapplicationcannotbeprocessedbytheMedicarecarrierGetStartedWith PECOSListofCPT/HCPCScodesICDProcedureCodingSystemICDCMTheProviderEnrollmentChainandOwnershipSystem(PECOS)isanational databaseofMedicareprovider,physician,andsupplierenrollmentinformationCMS&HHSsitesCMS&HHSsitesEnrollusingPECOS,itheonlineMedicare enrollmentsystemRevalidate(renew)yourenrollmentReportchangestoyourenrollmentrecordCompletetheonlinePECOSapplicationCMSI(PDF)for PhysiciansandNon-PhysicianPractitionersAnEFTauthorizationformmustbesubmittedforeachMedicarecontractortowhomyousubmitclaimsforMedicare payment.Reviewandupdateyourinformation.Requesta2ndappeal.PECOSistheonlineMedicareenrollmentmanagementsystemwhichallowsyouto:Enroll asaMedicareproviderorsupplierIntotal,CLIAcoversapproximately,laboratoryentitiesDownloadsPrintyourdateofbirth(mm/dd/yyyy)Checkthe appropriateboxforthepatient’ssexWhat’stheformcalled?PECOShasvideoandprinttutorialsandwillwalkyouthroughyourenrollmenttoensureyour informationisaccurateCMSB(Rev/)Toavoiddelaysintheenrollmentprocess,youshould:Completeallrequiredsections,asshowninsectionEnsurethatthe legalbusinessnameshowninsectionmatchesthenameonthetaxdocumentsStepCompletetheMedicareEnrollmentApplicationCMSB(PDF)forClinics, GroupPractices,andCertainOtherSuppliersCMSHTMLEnglish;CMSAccessibility&NondiscriminationforIndividualswithDisabilitiesNoticeYoucanide howoftentoreceiveupdatesRedeterminationRequest(CMS)What’situsedfor?PECOSisusedtocollectandmaintainthedatasubmittedonCMSenrollment form.Email.FurnishyourmailingaddressandincludeyourtelephonenumberThefollowingformscanbeusedforinitialenrollment,revalidations,changesinstatus, andvoluntarytermination:CMSA(PDF)forInstitutionalProvidersQuestionsaboutOnlytheCMSIissubmitted–Supposeanindividualpractitioner:(1)submits onlytheCMSIwithoutincludingtheCMSBandCMSR,and(2)indicatesontheCMSIthathe/shewillbereassigningallorpartofhis/herbenefitstothegroup practiceTheCentersforMedicare&MedicaidServices(CMS)regulatesalllaboratorytesting(exceptresearch)performedonhumansintheUSthroughthe ClinicalLaboratoryImprovementAmendments(CLIA)CMS;RelatedLinksPrintyourMedicareNumberexactlyasitisshownontheMedicarecard;;; ContactusaboutFormCMSElectronicFundsTransfer(EFT)()amtopmCT(amtopmET)M-Fy@DonotsubmitPHI/PIIthroughemailMedicare CoverageDatabase.WithdrawfromtheMedicareprogram.