Enroll in Medicare

Before jumping into Medicare Enrollment applications, it is best to be prepared. To ensure a provider has everything necessary to properly complete a Medicare application(s), check out the below table. Not all topics may apply to each applicant.

Prepare and Get Started

View Enrollment related terms on the Terms and Definitions webpage.

* Required for all applicants

Topic Brief Details
* Is Provider Eligible to Enroll in Medicare?
  • View a list of eligible Part B specialties on the Eligible Specialties webpage. If a specialty is not listed, that specialty is not able to enroll in Medicare.
  • If a provider is unsure of which taxonomy code to choose, he/she should visit the X12 website to view the Health Care Provider Taxonomy Code Set. Health Care Provider Taxonomy Codes define a health care service provider type, classification, and area of specialization.
*Obtain NPI via NPPES as it is required for all providers/suppliers * If Eligible, enroll as Group Member, Organization, Sole Owner, or a Sole Proprietor? NPPES - Individuals and organizations use NPPES to apply for NPIs and to keep their NPI information up-to-date, including addresses, phone numbers, and taxonomy codes

Individual providers must obtain a Type 1 (Individual) NPI.
Organizations must obtain at least one Type 2 (Organization) NPI. The number of type 2 NPIs an organization obtains is an individual business decision.
  • Type 1 NPI - Physicians and non-physician practitioners
  • Type 2 NPIs - Physician groups, hospitals, nursing homes, group practices, pharmacies (not all-inclusive listing)
When there are changes in information such as name, tax identification number (TIN), address, primary practice location, taxonomy code, contact person and/or authorized officials, providers must update their NPPES information and their Medicare enrollment within 30 days

View the National Provider Identifier (NPI) webpage for more details.
Is Provider Enrolling to Bill CAH Method II? If providing Part B services in a Critical Access Hospital (CAH), a provider must be reassigned to the CAH Provider Transaction Access Number (PTAN) and NPI(s). Watch our Enrollment on Demand Application Tutorials for proper application instructions.
Is Provider Enrolling to Order, Certify and/or Prescribe Only? If a provider does not want to bill Medicare but is looking to enroll for the sole purpose of ordering, certifying, and/or prescribing Part D drugs, view the Ordering, Certifying, and Prescribing webpage.
PECOS Applicable to providers using PECOS Web to apply or make changes (PECOS Web allows providers to securely submit applications and review/update current file information via the Internet)

I&A is the gateway to PECOS and manages who has access to change those enrollments. Everyone using PECOS must use their own User ID and Password. This User ID and Password combination is managed by the I&A. Use provider NPPES login for the I&A.

To learn more about I&A, PECOS and to access PECOS Web Required Information Checklists, visit our PECOS webpage.

Participate or Not Participate?

 Applicable to Organizations, Sole Owners and Sole Proprietors only

To participate or not participate is a personal choice. To make an educated decision, a provider or supplier should carefully read and analyze the advantages and disadvantages of participation. He/she should also carefully evaluate the provider pricing fee schedule, and other fee schedules that may apply, to determine the impact this decision will have on the reimbursement amount.

To participate in the Medicare program means that the provider/organization agrees to accept assignment for all services furnished to Medicare beneficiaries. Becoming a Participant means you agree to accept the amount approved by Medicare as total payment for covered services. More information available on the Participation webpage

A nonparticipating provider is a provider involved in the Medicare program who has enrolled to be a Medicare provider but chooses to receive payment in a different method and amount than Medicare providers classified as participating. The nonparticipating provider may receive reimbursement for rendered services directly from their Medicare patients. They submit a bill to Medicare so the beneficiary may be reimbursed for the portion of the charges for which Medicare is responsible. More information available on the Nonparticipation webpage

Application Time Frames

Application Type Processing Time with an Onsite Visit Processing Time without an Onsite Visit
PECOS It can take 50-85 calendar days before application is completed It can take 15-50 calendar days before application is completed
Paper It can take 65-100 calendar days before application is completed It can take 30-65 calendar days before application is completed

Required Applications and Tips

Providers may submit applications in one of two ways.

  1. Internet-based PECOS (highly encouraged method) - PECOS Web allows providers to securely submit applications and review/update current file information via the Internet. Prior to submission, providers must upload all required supporting documentation and electronically sign the certification statement
  2. Paper - Access all forms, view tutorials and read application instructions from the Noridian Forms webpage
  3. Enrollment on Demands (EoDs) - Step-by-step self-paced tutorial to help providers complete an application. For more information, view the Enrollment on Demand (EoD) Tutorials for Part B Specialties webpage.
Provider Type Required Application(s) Tips

Organization

  • Two or more owners.
  • Obtain at least one Type 2 NPI.
  • Bills with an EIN.
  • Can be sold.
  • After starting a PECOS application, select "Clinics/Group Practices and Certain Other Suppliers"
  • Complete all sections of CMS-855B
  • Attach all supporting documentation such as IRS document.
  • CMS-588 EFT, voided check/bank letter. EIN required to be on application in Tax Identification Number (TIN) field
  • List all directors, board members, and contracted or W-2 managing employee
  • Ensure that someone is marked as a contracted or W-2 managing employee
  • Fees may be required. View Application Fee webpage to see if this applies

Organization must have at least one rendering provider

If provider not enrolled, submit CMS-855I

If provider is actively enrolled, submit CMS-855I

Sole Owner

  • Owner of a Professional Corporation (PC), Professional Association (PA), or sometimes a Limited Liability Company (LLC)
  • Must obtain both a Type 1 and type 2 NPI. Bills through corporate business entity using an EIN.
  • Has personal assets that are legally separate from business.
  • Can be sold.
  • After starting a PECOS application via the individual, choose "Individual Physician or Non-Physician Practitioner" next select Sole Owner
  • Complete sections 1, 2, 3, 4A-4F, 6, 8, 13, and 15 of CMS-855I
  • Attach all supporting documentation such as Diploma, Internal Revenue Service (IRS) document, Certification, CMS-588 Electronic Funds Transfer (EFT) and voided check/bank letter
  • CMS-588 EFT, voided check/bank letter. EIN required to be on application in TIN field

Partnership

  • Pertains to a PLLC, LLC Partnership.
  • A partnership is an association of two or more persons/entities who carry on a business for profit.
  • Each partner in a partnership is an owner. Obtain at least one Type 2 NPI. Bills with an EIN.
  • Can be sold.
  • After starting a PECOS application, select "Clinics/Group Practices and Certain Other Suppliers"
  • Add Partnership in Individual with Ownership Managing Control topic
  • Attach all supporting documentation such as Internal Revenue Service (IRS) document, Certification, CMS-588 Electronic Funds Transfer (EFT) and voided check/bank letter
  • CMS-588 EFT, voided check/bank letter. EIN required to be on application in TIN field

Partnerships must have at least one rendering provider

If provider not enrolled, submit CMS-855I

If provider is actively enrolled, submit CMS-855I

Sole Proprietor

  • Is legally one and same with business and is personally responsible for any business financial obligations.
  • Must obtain only an Type 1 NPI.
  • Can bill with their SSN or a non-incorporated EIN. Files taxes with a Schedule C (1040).
  • Cannot be sold unless Disregarded Entity.
  • After starting a PECOS application, choose "Individual Physician or Non-Physician Practitioner" next select" Self-Employed/Sole Proprietor"
  • Complete sections 1, 2, 3, 4A-4E, 6, 8, 13, and 15 of CMS-855I
  • Attach all supporting documentation such as Diploma, IRS document (if billing with EIN), Certification
  • CMS-588 EFT, voided check/bank letter. SSN required to be on application in TIN field

Group Member

  • Individuals who reassign all benefits to an organization or another individual.
  • Have an arrangement with an employer to send in Medicare claims to receive payment for services rendered.
  • PECOS application
  • Approved providers reassigning benefits: CMS-855I
  • New providers reassigning benefits: CMS-855I
  • Physician Assistant (PA): CMS-855I only
  • After starting a PECOS application, choose "Individual Physician or Non-Physician Practitioner" next select "Group Member Only."
  • Complete sections 1, 2, 3, 4F, 13, and 15 of CMS-855I
  • Physician Assistants (PAs) complete sections 1, 2, 2I, 13 and 15 of CMS-855I
  • List all reassignments, Provider Transaction Access Numbers (PTANs) and National Provider Identifiers (NPIs) in which provider will render services
  • Attach all supporting documentation such as Diploma and Certification
  • If provider has completed the e-signature process in PECOS, there is no need to sign and mail a paper signature as well
  • Ensure correspondence address is up to date and a location that is regularly monitored
  • If provider receives an email regarding being active in another state and is still active in that state, it may be disregarded. However, if no longer providing services in those states, send an application to terminate. See Withdraw from Medicare webpage for details

What a Provider Should Expect After Application Submission

  • When a provider application is completed, a notification letter will be sent. Letter will state whether application has been approved, rejected or denied
  • Corrections or additional information may be required to complete the processing of an application. Requests will be sent to contact person on application, if provided. Information must be submitted within 30 days of date of request
  • A PTAN will be issued and shown on the approval letter. See Provider Transaction Access Number (PTAN) webpage for details.

Provider may begin billing:

  • Enroll with Electronic Data Interchange (EDI) to bill electronically, visit EDISS for more information. Select state you are enrolled in
  • If there are any changes that must be made to enrollment following approval, complete a new form with any changes within 30 days to avoid revocation

CMS requires providers/suppliers to revalidate every five years. View the Revalidation webpage for details.

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