Enroll in Medicare
- Prepare and Get Started
- Required Applications and Tips
- What a Provider Should Expect After Application Submission
Before jumping into Medicare Enrollment applications, it is best to be prepared. To ensure a provider has everything necessary to properly complete the applicable application(s), check out the below table. Not all topics may apply to each applicant.
* Required for all applicants
* Is Provider Eligible to Enroll in Medicare?
* If Eligible, Group Member, Organization, Reassiging benefits, Sole Owner, or a Sole Proprietor?
To further help explain the differences, watch our How Do I Determine What I Am? Tutorial.
* If Eligible, Provider Must Obtain NPI via NPPES
Organizations, Suppliers, Physicians, or non-Physician Practitioners who want to bill Medicare must obtain a National Provider Identifier (NPI) via National Plan and Provider Enumeration System (NPPES). NPIs are used in administrative and financial transactions.
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
NPI: What You Need to Know - Learn more about sole proprietors and difference between Type 1 and Type 2 NPIs
Individual providers must obtain a Type 1 (Individual) NPI, and organizations must obtain at least one Type 2 (Organization) NPI. The number of type 2 NPIs an organization obtains is an individual business decision.
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.
Sign Up for the Identity & Access Management System (I&A)
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 IA&, 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 physician 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 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 Nonparticipation webpage
* Have Supporting Documents Available
- 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
- Paper - Access all forms, view tutorials and read application instructions from the Noridian Forms webpage
|Provider Type||Required Application(s)||Tips|
|Group Member|| || |
Organization must have at least one rendering provider
If provider not enrolled, submit CMS-855I and CMS-855R
If provider is actively enrolled, submit CMS-855R
To check if provider is enrolled, go to Data.CMS.gov
|Sole Owner|| || |
|Sole Proprietor|| || |
- 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 in regards to 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
- Application Processing Time
- Initial paper application with onsite visit: 80-210 days
- Initial paper application without onsite visit: 60-180 days
- Initial web application with onsite visit: 80-120 days
- Initial web application without onsite visit: 45-90 days
- When a provider application is completed, a notification letter is sent. Letter will state whether application has been approved, rejected or denied
|Application Status||Brief Description|
|Approved|| Provider may begin billing |
|Rejected||Provider must start over with a new application, new signatures, etc.|
|Denied|| Provider doesn't meet qualifications Medicare has set and was not enrolled |
CMS requires providers/suppliers to revalidate every five years. View the Revalidation webpage for details.
Last Updated May 09, 2017