Submit Enrollment Application

PECOS Enrollment Process and Advantages

The Internet-based PECOS can be used in lieu of the paper enrollment application.

Submitting the application via PECOS is the preferred method.

Advantages of Online Enrollment:

  • Lets you submit CMS-855 form online
  • MAC receives application submission faster
  • Tailored application process
  • Electronic signature method
    • E-signature
    • Upload (PDF or TIFF) paper certification statement
  • Uploading (PDF or TIFF) supporting documentation feature
  • Processing time is 50 percent faster than paper application submission
  • Fewer submission errors/omissions
  • Saves time and money

The system allows you to securely review information currently on file, update and submit via the Internet.

Important: PECOS has two separate enrollment records for sole owners, the group enrollment and the individual enrollment. When submitting a change of information or revalidation verify and update (when applicable), the information on both enrollments.

Related Content

Revised 6/24/2024

Helpful Resources

Check Provider Enrollment Application Status
Log Into PECOS
Pay Application Fee

J6 Mailing Address:

National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475

Interactive Voice Response:

877-908-9499

Contact Enrollment:

877-908-8476

Hours Available:

Monday–Friday
8:00 a.m.–4:00 p.m. CT

Form(s) you'll need:

Enrollment Forms

Helpful Resources

Check Provider Enrollment Application Status
Log Into PECOS
Pay Application Fee

JK Mailing Address:

National Government Services, Inc.
P.O. Box 7149
Indianapolis, IN 46207-7149

Interactive Voice Response:

877-869-6504

Contact Enrollment:

888-379-3807

Hours Available:

Monday–Friday
8:00 a.m.–4:00 p.m. ET

Form(s) you'll need:

Enrollment Forms