NOTE: CMS’ Internet-based PECOS Web system supports the Medicare enrollment process by capturing provider/supplier information from the CMS-855 family of forms. The system manages, tracks, and validates enrollment data electronically via the Internet. PPS uses the PECOS internet application process instead of the paper application process outlined in the table below.

Type of Provider	855A	855B	855I	855R	588	460	8275/76	8262
Individual or Sole Proprietor (Not Incorporated)
Individual Provider (Incorporated)
Individual Reassigning Benefits
Clinic or Group Practice
Organization Part B
Institutional Provider Part A

= Required = Optional

For more information on Medicare enrollment, please refer to the comprehensive reference guide at Highmark Medicare found here: Reference Guide.