Credentialing
Medicare Enrollment for Providers: PECOS, CMS-855I and Revalidation
Medicare provider enrollment sets your effective date, and you can bill for services no more than 30 days before that date (90 after a declared disaster), under 42 CFR 424.521. We prepare the CMS-855I or PECOS application, answer First Coast's requests and keep the enrollment current through revalidation.
The short answer
How does Medicare provider enrollment work?
File the CMS-855I in PECOS or on paper (no Medicare fee for physicians and practitioners), answer any request for information within 30 days, and check the approval letter for your PTAN and effective date. CMS's processing targets run from 15 to 100 calendar days. The Advixor Group prepares the application, answers First Coast's requests and keeps the enrollment current through revalidation.
SourcesCMS, MLN9658742Program Integrity Manual, ch. 10First Coast processing timeframes
Which form
CMS-855I, 855B or 855O: which Medicare application you file
Every other credentialing fee, Florida Medicaid fingerprinting included, is in one table on credentialing cost.
| Situation | Form | What to know | Medicare fee (2026) |
|---|---|---|---|
| New physician or practitioner | CMS-855I or PECOS | Pick your applicant description (sole owner, sole proprietor, group member, disregarded entity); direct deposit (CMS-588) required | $0 |
| Joining a group | CMS-855I Section 4F, or the group’s CMS-855B Section 4H | The CMS-855R is discontinued | $0 |
| New physician or practitioner group (PA, PC or LLC) | CMS-855B | Type 2 NPI and EIN | $0 |
| Ordering or certifying only | CMS-855O | For practitioners who never bill Medicare | $0 |
| Institutional provider or equipment (DMEPOS) supplier | CMS-855A or CMS-855S | State survey or accreditation (855A); CMS’s national contractor, not First Coast (855S) | $750 |
| Change of information | Same form or PECOS | 30 days for ownership, a location or an adverse legal action; 90 days for the rest | $0 |
| Revalidation | Same form or PECOS | Every 5 years (3 for DMEPOS); submit within 60 days of CMS’s notice | $0 ($750 institutional) |
Sources CMS, MLN9658742 (December 2025); 42 CFR 424.515 and 424.516; 90 FR 55738 (Dec 3, 2025).
Who else files
Medicare Part B providers beyond physicians: NPs, PAs and therapists
NPs, PAs, clinical nurse specialists, certified nurse-midwives, clinical social workers, marriage and family therapists (MFTs) and mental health counselors (MHCs) file the same CMS-855I as physicians.
- PAs have enrolled and been paid directly since January 1, 2022 (NP and PA credentialing).
- MFTs and MHCs bill for services from January 1, 2024, never earlier (mental health credentialing; therapy practices).
- Telehealth from home: with an office, enroll and bill from it; if home is your only location, enroll it as “Home office for administrative/telehealth use only” to keep the address off Care Compare.
- Each state where you render services needs its own CMS-855I.
PECOS clocks
PECOS enrollment: the deadlines after you file
Site inspectors may arrive unannounced with a photo ID and a signed CMS letter; a visit they can’t complete can mean denial or revocation. The approval letter lists your PTAN, effective date and participation status.
PECOS clears out idle applications.
- 120 dayswithout activity, and an application in New or Edit is deleted.
- 20 daysto resubmit an application Opened for corrections, or it is deleted.
- 30 daysto answer an application Returned for corrections (First Coast’s request for information), or it is rejected.
- 60 daysto reopen a Rejected application, or it is deleted.
Source CMS, MLN9658742 (December 2025).
Processing time
How long Medicare provider enrollment takes
CMS publishes no average, only contractor targets, and their clock stops for referrals to CMS or the OIG, license-board checks, fingerprinting and NPPES fixes.
Florida’s contractor, First Coast Service Options, served 2,397,325 fee-for-service beneficiaries and 82,110 physicians across Jurisdiction N (Florida, Puerto Rico and the U.S. Virgin Islands) as of Sept 30, 2025.
Sources CMS Program Integrity Manual ch. 10, §10.5 (Rev. 13415); First Coast processing timeframes (Feb 18, 2026).
Getting paid
Your effective date: when Medicare starts paying a new provider
Under 42 CFR 424.520(d)(1), the effective date for physicians, practitioners and their groups is the later of:
“(i) The date of filing of a Medicare enrollment application that was subsequently approved by a Medicare contractor; or (ii) The date that the provider or supplier first began furnishing services at a new practice location.”
Opening a practice? File once the location and license are ready; filing early costs nothing, because the effective date waits for your first patient.
Participation
Participating, non-participating or opting out of Medicare
- The approval letterYou have 90 days from it to sign the CMS-460 participation agreement.
- Mid-November to December 31Otherwise, wait for open enrollment.
- January 1An agreement signed at open enrollment takes effect.
Source CMS, MLN9658742 (December 2025).
- Non-participating: paid 5% less; on a claim not taken on assignment, you charge at most the limiting charge, 115% of the non-participating fee schedule amount (42 CFR 414.48).
- Reassigned to a group: you take the group’s status and file no CMS-460.
- NPs, PAs, clinical social workers, MFTs and MHCs: every claim on assignment, whatever the status.
- Opting out: a private contract with each Medicare patient and an affidavit with every MAC you would bill. Medicare and Medicare Advantage plans then pay you nothing (42 CFR 405.425) except for emergency or urgent care (405.440), though you can still order, certify and prescribe. Organizations can’t opt out.
- Opt-out dates: participating physicians start at a calendar quarter, filing at least 30 days ahead; others on the day they sign the affidavit, if they file it within 10 days of the first private contract. It renews every 2 years unless cancelled in writing at least 30 days before the end, and a first opt-out can be undone within 90 days (42 CFR 405.410 and 405.445).
We talk through participation and opt-out with you before anything is signed.
Staying enrolled
Revalidation: keeping your Medicare credentialing current
From approval on, your revalidation date sits on the same calendar as your commercial recredentialing.
- Due dates post on the Medicare Revalidation List up to 7 months ahead; First Coast’s notice comes 90 to 105 days out under the Program Integrity Manual, or 90 to 120 under CMS’s MLN booklet. Filed more than 7 months early unasked, a revalidation is returned.
- Deactivation can follow 6 consecutive months without a Medicare claim, a change reported late, or a revalidation package not complete within 90 days of the notice; for the last two, CMS can date it back to the day you fell out of compliance (42 CFR 424.540).
- Extensions: CMS’s page says none; the Program Integrity Manual allows a request only without the full 7 months’ notice.
- Reassignments: a missed revalidation ends every one tied to you.
What’s included
What our Medicare provider enrollment service includes
CAQH and NPI
Which plans read DataSpring (CAQH), how to register, and NPI types and taxonomy codes.
Learn morePTAN number
Find, check and use the PTAN on your approval letter.
Learn moreRecredentialing
Renewal cycles side by side, from the 120-day CAQH re-attestation to Medicaid renewal.
Learn morePayer enrollment
Plan-by-plan enrollment with commercial and Medicare Advantage insurers, and what to do when a network is closed.
Learn moreNP and PA credentialing
Florida practice status, Medicare's NP and PA payment rate, and own-NPI versus incident-to billing.
Learn moreMental health credentialing
License-by-license credentialing for therapists, what behavioral networks check, and Medicare telehealth rules.
Learn moreQuick answers
Medicare provider enrollment: PECOS, PTAN, billing and opt-out questions
PECOS or paper, your provider number, billing, Medicare Advantage networks, opting out and ordering-only enrollment. Ask the rest in a consultation.
What is PECOS, and can I enroll on paper instead?
How do I get a Medicare provider number?
How do I bill Medicare once I'm enrolled?
Does Medicare enrollment put me in network with Medicare Advantage plans?
Can I opt out of Medicare and still treat Medicare patients?
What does "PECOS enrolled" mean if I only order labs or imaging?
Talk to an advisor
You care for patients. Who’s taking care of the business?
Tell us where your practice is today. We will tell you what we would do first.
Official sources
- CMS, Medicare Provider Enrollment (MLN9658742) (December 2025), read Oct 19, 2026
- CMS, Program Integrity Manual, chapter 10 (Oct 13, 2026), read Oct 17, 2026
- eCFR (current as of Oct 15, 2026), read Oct 19, 2026: 42 CFR part 424, part 405, subpart D (opt-out), 414.48 and 422.204
- CMS, Revalidations and Enrollment Applications, read Oct 17, 2026; Ordering & Certifying and Telehealth FAQ (updated 10/8/26), read Oct 19, 2026
- CMS, A/B MAC Jurisdiction N (07/08/2026), read Oct 17, 2026
- First Coast, CMS-855 processing timeframes and Determining your Medicare effective date (Feb 18, 2026), read Oct 17, 2026
- Federal Register, 90 FR 55738 (Dec 3, 2025), the 2026 application fee, read Oct 17, 2026