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Open Enrollment

Each year the government gives providers an opportunity to become "Medicare participating providers" or to discontinue their participation. The annual enrollment period is usually 45 days in length and generally begins in mid-November, to become effective January 1st, but may occasionally be delayed due to changes enacted by Congress. The participation (or non-participation) status of a provider will remain in effect through December 31 of each year and will renew automatically for the next 12-month period unless the provider gives written notice of his or her intent to change their status during the enrollment period (mid-November through December 31 annually).

A postcard is being mailed to remind the provider community of the current Open Enrollment period. If you are not certain how you or your business is currently set up, log in to PECOS Web This link takes you to an external website., to check your enrollment participation status. If you plan to change status during open enrollment, we recommend you hold billing until notified your status has been changed. Noridian is unable to submit claims revisions on your behalf for this reason.

Participating

Only a valid CMS 460 - Medicare Participating Physician or Supplier Agreement will be accepted for all providers choosing to participate in Medicare. The effective date of the Participation Agreement for a new provider outside of the annual enrollment period is the date in which the Participation Agreement is received by Medicare.

When a physician is a member of a clinic that has been approved by Medicare to receive group reimbursement, the clinic as a whole must choose to participate or not participate. If the clinic chooses to participate, an authorized representative (e.g., clinic administrator, Chief Executive Officer, President, etc.) signs the agreement on behalf of the entire clinic or group practice. An office manager/billing clerk is not an appropriate representative for the group.

Participating providers should do the following activities during the Open Enrollment period.

Requested Status for Next Year Action Needed
Participating No Action Required
NonParticipating Mail/fax a letter signed by provider (or authorized/delegated official for a group) stating that the nonparticipating status is being requested for next year.

NonParticipating

Providers enrolling with Medicare who choose to be classified as nonparticipating must have their authorized representative notify us of this intent on the company/individual's letterhead. Non-Participating providers should do the following activities during the Open Enrollment period.

Requested Status for Next Year Action Needed
NonParticipating No Action Required
Participating Mail a Participation Agreement to Medicare.

 

Last Updated Nov 09, 2017