How will I know if I have successfully submitted my enrollment application?
Once the Internet application has been electronically submitted, the “Submission Receipt” page appears. This page informs the physician or non-physician practitioner that the Internet application has been submitted for processing. The “Submission Receipt” page reminds the physician or non-physician practitioner that the Certification Statement must be signed and the Certification Statement and the supporting documentation must be mailed to the contractor. PECOS sends a notification reminder to each e-mail address listed in the contact person information section of the application.
Note: A Medicare contractor will not process an Internet enrollment application without the signed and dated Certification Statement and the required supporting documentation. In addition, the effective date of filing an enrollment application is the date the Medicare contractor receives the signed Certification Statement that is associated with the Internet submission.
The Certification Statement must be signed by the physician or non-physician practitioner enrolling or making a change to his/her enrollment information. Signatures must be original and in ink (blue ink recommended). Copied or stamped signatures will not be accepted.
