Enrollment Applications | CMS - Centers for Medicare & Medicaid Services
The following forms are routinely submitted with an enrollment application: Electronic Funds Transfer (EFT) Authorization Agreement (Form CMS-588 (PDF)) Medicare Participating Physician or Supplier Agreement (Form CMS-460 (PDF)) Submit Your Application. When you’ve completed your paper application, print it and sign it.
Welcome to the Medicare Provider Enrollment, Chain, and …
PECOS supports the Medicare Provider and Supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information. New to PECOS? View our videos at the bottom of this page.
Clinics, group practices, and other suppliers must complete this application to enroll in the Medicare program and receive a Medicare billing number. The paper CMS-855B enrollment application. Be sure you are using the most current version.
Enrollment Forms - Medicare
Get the forms you need to sign up for Part B including CMS-40B, CMS-L564, CMS-10797, and CMS-10798.
Physicians and non-physician practitioners can apply for enrollment in the Medicare program or make a change to their enrollment information (including adding or terminating a reassignment of benefits) using either: The paper CMS-855I enrollment application. Be sure you are using the most current version.
Sign up for Medicare | SSA
Medicare is our country’s health insurance program for people age 65 or older. You’ll sign up for Medicare Part A and Part B through Social Security, so you can make both retirement and Medicare choices and withhold any premiums from your benefit payments.
How do I sign up for Medicare?
(You’ll need to create your secure my Social Security account to sign up for Medicare or apply for benefits.) Contact your local Social Security office. If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
Ready to sign up for Part A & Part B - Medicare
You’ll create your secure my Social Security account to sign up for Medicare or apply for Social Security benefits online. You can only sign up for Part B (or Part A if you have to pay a premium for it) at certain times.
Medicare Advantage Applications | CMS
Medicare Contract Applications - Organizations that are interested in applying for a Medicare Advantage contract can download and complete the appropriate application. All Medicare Advantage applicants must download the payment information form below and submit it …
Eligibility, Enrollment, and Renewal Tools and Resources | Medicaid
This section contains guidance and technical assistance tools related to the Medicaid and CHIP application, enrollment and fair hearings process. Renewal Strategies and Tools. This section contains tools and resources designed to assist states in executing accurate eligibility renewal processes for Medicaid and CHIP beneficiaries.