Planning guidance only—not a guarantee. Requirements, network capacity, contracting, and payer review can affect timing and effective dates.
Medicare provider and supplier enrollment is administered by the Centers for Medicare & Medicaid Services (CMS), with operational processing by Medicare Administrative Contractors (MACs). It is not commercial-network contracting, and the correct enrollment application depends on whether the applicant is an individual professional, group, institution, supplier, or another entity type.
CMS identifies PECOS as the online system for securely submitting and managing Medicare enrollment information. CMS’s enrollment resources also identify the CMS-855I for physicians and non-physician practitioners and the CMS-855B for clinics, group practices, and other suppliers. Select the current CMS instructions and form for the applicant and transaction.
Individual enrollment, group enrollment, reassignment of benefits, and enrollment with a particular MAC are related but distinct. CAQH is not a CMS Medicare enrollment requirement. Medicare Advantage plans are privately administered plans and have separate provider participation processes from Original Medicare enrollment.
CMS notes that PECOS applications tend to process faster than paper applications, but it does not publish one approval promise that applies to every application. Follow the MAC’s correspondence and the applicable effective-date rules before billing.
The enrollment path
Documents to have on hand
Frequently Asked Questions
Is CAQH required for Original Medicare enrollment?
No. CMS directs Medicare provider and supplier enrollment through PECOS or the applicable CMS-855 enrollment application, not CAQH.
Does Medicare enrollment include Medicare Advantage networks?
No. Original Medicare enrollment is separate from participation with individual Medicare Advantage plans, which are administered by private organizations.
Which effective date controls Medicare billing?
Follow the enrollment notice and applicable effective-date rules communicated by CMS or the relevant MAC for the specific enrollment situation.
These state links are related Arctic Health credentialing guides for this profile’s listed markets. Product availability, plan or network participation, provider types, and open panels vary by location; confirm current requirements directly with the payer before relying on a market listing.
Reviewed by Arctic Health Team , Credentialing Specialists
Last reviewed: September 2026
Information on this page reflects our experience as of September 2026. Credentialing requirements, payer processes, and state regulations may change. Contact us or check the relevant state medical board and payer websites for the most current requirements. This content is for informational purposes only and does not constitute legal or professional advice.