Pharmacy - JE Part B

Learn how to enroll a Pharmacy into Part B Medicare.

• Pharmacy
• Application Completion
• Effective Dates
• Supporting Documentation

Pharmacy

• Information is found in CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 15 Section 4.2.4
• Pharmacy is an entity that bills for medication that is prescribed to a patient
  • Pharmacies are typically enrolled with DME, however; there are certain Medicare covered drugs that are billed through Part A/B
• The pharmacist will not enroll in Medicare as they are not a specialty that is allowed to enroll into Medicare.

Application Completion

• If completing application via PECOS, ensure application questionnaire is answered correctly. CMS-855B, CMS-588 (Electronic Funds Transfer (EFT)) application will populate.
• If completing application via paper, the following must be submitted:
  • CMS-855B
  • CMS-588 (EFT)
• A voided check or signed bank letter is necessary documentation for EFT portion of application
• Must include legal business name (LBN) of the enrollment, routing and account number and practice address
• CMS-460 (Participation agreement)
  • This is optional.
  • View Participation webpage for details
• Submit application fee
  • Fee is required for application. Can be paid on PECOS website
  • Select pay application fee on right-hand side under Helpful Links

Effective Dates

• Medicare can go back 30 days from when the application is submitted, or all signatures are received in PECOS.
• An application can be submitted 60 days in advance of when the enrollment will be active.

Supporting Documents

• IRS document when:
  • Initial enrollment
  • A change of legal business name
• A voided check or signed bank letter is necessary documentation for EFT portion of application