The Enrollment section is intended to familiarize your organization with information contained on the CMS-855A Medicare Federal Health Care Provider Enrollment Application for Health Care Providers that Bill the Medicare Administrative Contract and the Medicare Part A Provider Enrollment process.


Download the 855A Medicare Enrollment Form in an electronic format with electronic edits.  Also take advantage of the Part A Enrollment Packet that’s available with useful resources to assist with Medicare Part A enrollment process.  Prior to submitting your application, review the top reasons for an application to be developed and/or returned to the provider.

Check Status of Current Application

Have you already submitted your application?  If so, use the reference number from your acknowledgement letter to check it’s status.

Electronic Funds Transfer (EFT)

With the issuance of Version 4/06 of the CMS-855A Medicare Enrollment Application, CMS mandated Electronic Funds Transfer.  The enrollment application cannot be approved unless the EFT agreement is on file.

Internet-based PECOS

CMS supports the Medicare Provider and Supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information.

Provider-Based Status Determinations

This will assist the provider by ensuring the necessary requirements are met and that all appropriate supporting documentation is submitted with the request.

Provider Information Change

Need to make a change?  CMS has established requirements and procedures for handling provider information changes.


Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria.

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