Pharmacy Billing Setup Intake Form

Complete one form for each pharmacy location. This takes about 15 minutes if you have everything ready.

Before you start, gather:

• The pharmacy location NPI (10 digits)
  Where do I find this?

  It is printed on pharmacy claims and enrollment documents, and can be searched by pharmacy name and state at the NPPES NPI Registry.
• The NPI of every pharmacist who works at this location
  Where do I find this?

  Each pharmacist can look up their own NPI in the NPI Registry. Tip: collect these from your staff before you begin.
• Every Medicare PTAN for this location
  Where do I find this?

  From your MAC approval letter, or from PECOS (see the upload step for instructions).
• Access to PECOS, or the person who has it
  Where do I find this?

  Usually only the pharmacy owner or authorized official can log in. Arrange time with them before starting.
• A PDF of the PECOS "Existing Enrollments" page (strongly recommended)
  How do I get this?

  Log in to PECOS, open Existing Enrollments, and use your browser's Print function with "Save as PDF."
• Contact details for your program champion (name, email, mobile)

I have gathered what I need, or I understand I can come back and update later. Continue