cms 855a application fee


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PDF Application Fee requirements for Institutional Providers

* For providers and suppliers reporting a change of ownership via the Form CMS-855A the ownership change does not require an application fee

PDF INSTITUTIONAL PROVIDERS CMS-855A

• Pay the required application fee (via pecos cms hhs gov/pecos/feePaymentWelcome do) upon initial enrollment the addition of a new practice location and revalidation PRIOR to completing and submitting this application to your MAC CMS-855A (09/23) 3

PDF 855A Enrollment & Policy Overview

Application fee for institutional providers for 2017 - $560 Section 1A – Basic Information – Reason for Application Changes must be reported within 30 or 90 days Revalidation every 5 years – DO NOT wait to report changes of information

PDF Medicare Application Fee Fact Sheet

Medicare enrollment application using the CMS-855A CMS-855B (except physician and non-physician practitioner organizations) or CMS-855S or associated Internet-based PECOS* enrollment application Fee Usage

  • What does Pecos stand for?

    PECOS stands for Provider, Enrollment, Chain, and Ownership System.
    It is the online Medicare enrollment management system that allows individuals and entities to enroll as Medicare providers or suppliers.

  • How do I apply? Apply online at mymedicaid-florida.comopen_in_new.
    From the home page, hover over Provider Services and select “New Medicaid Providers” under the Enrollment section.
    If you are a network health care professional for other Florida Medicaid health plans, you only need to submit 1 application.

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