Da 2062 Form 2024

Da 2062 Form: What You Should Know

Fax this application to 1-877-MEDICARE (). PECOS, the Centers for Medicare & Medicaid Services' Overview The Medicare Provider Enrollment, Chain, and Ownership System (PECOS) provides a single electronic form providing a single means for an individual to submit all forms necessary to receive and pay for services from Medicare-participating providers. The system includes a link to a CMS-855I enrollment application, as well as a complete list of links to all forms and documents used to collect, upload, submit (e-pay) and pay for services from PECOS and the Medicare Benefits Administration (MBA). This system is based upon the premise that Medicare consumers will submit a completed application when applying for Medicare services. A completed application establishes the physician's access code and provides the primary billing address for physician services under Medicare. The PECOS system supports the “pay as you go” principle that Medicare consumers will only use the enrollment form to receive payment. The system includes a link to CMS's fee schedule of payment for all physician services. Payment rates are based on the primary payer information on the forms that are received (e.g., “DCA” on the PECOS application is the billing address of the physician; no authorization is requested in the form until such information has been received). If a provider participates in the CMS fee schedule, the Medicare consumer is charged the same or similar rates on all covered services that have the same or similar Medicare benefit package, as specified on the PECOS application. This “pay as you go” principle is enforced in the form of fees for the PECOS application. A non-payer, or the person who does not appear on Medicare claims at their address, will only be charged payment rates that are in accordance with the rules of the payment system (e.g., any person who does not appear to be on Medicare at Medicare's primary address will be charged different payment rates from that which is set by the PECOS application; this will provide a measure of accountability for providers who use PECOS to collect payment for services). Payment fees are also paid on the PECOS application if the provider's primary address is on Medicare or if a payment cannot be made from one of these sources because the address on record is not known to either Medicare or the non-payer.

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