Order, Certify, Prescribe Part D Drugs - JE Part B
Order, Certify and/or Prescribe Part D Drugs
View the below related information on this page.
Ordering, Certifying and Prescribing Physicians and Other Eligible Professionals
- Enroll solely to order, certify and prescribe items or services for Medicare Beneficiaries
- Will not receive reimbursement for services
Is not currently enrolled to receive reimbursement for services
Providers already enrolled to bill for services may:
- Bill for services rendered
- Order and Certify items or services
- Prescribe Part D drugs
- Providers already enrolled to bill for services may:
- Only required to be enrolled in one state
Wants to prescribe Part D prescription drugs and has not Opted Out
- If social security number (SSN) and National Provider Identifier (NPI) is not on Opt Out Affidavit, provider is not enrolled to order, certify and/or prescribe services
- If SSN and NPI is on Opt Out Affidavit, provider is enrolled to order, certify and prescribe Part D drugs
Can change status from Ordering, certifying and Prescribing to billing for services by completing an Initial Enrollment
- Unless provider will no longer be billing for services rendered, do not submit CMS-855O application
- Only required to submit an application to order and certify, Enroll for Reimbursement or an Opt Out Affidavit to be eligible to prescribe Part D drugs
- Must submit CMS-855O application via Internet-based PECOS or via paper
View a list of specialties able to order certify and prescribe Part D drugs.
The most up to date list of individual providers with an approved ordering/certifying/prescribing enrollment in Medicare is the CMS list of ordering/ certifying/prescribing practitioners. Verify active enrollment to order/certify/prescribe in Medicare in CMS National Ordering, Certifying, and Prescribing Database.
If provider NPI is listed
- Provider is eligible to order/certify
- Provider is eligible to prescribe Part D drugs
- No application is necessary
If provider NPI is not listed
- Provider is not eligible to order/certify
- Beneficiary will be denied for Part D drugs prescribed at point of sale on CMS established date
- Submit CMS-855O application via Internet-based PECOS or via paper
If provider NPI is not listed but has an active I enrollment, contact the Provider Enrollment Contact Center
- Tell the representative the national database was checked
Providers may log into CMS Internet-based PECOS to verify or change enrollment information at any time. Such updates include changes from ordering/referring to billing of services.
Changes to be made to a provider's Ordering/Certifying/Prescribing enrollment must be sent to the original MAC the provider applied with.
If changes are not sent to the original MAC, the application will be returned to the provider.
- Ordering/Certifying means that providers want to order services for a Medicare beneficiary or refer them to another provider for services and will not receive reimbursement for services rendered
- If a provider enrolls as an ordering, certifying, and prescribing provider, the provider has chosen not to submit services to Medicare for reimbursement
- If enrolled as an ordering/certifying provider, provider is eligible to prescribe Part D drugs
- To become an ordering/certifying/prescribing provider, provider must obtain an NPI
To enroll as an ordering, certifying and prescribing provider, provider must complete and submit a CMS-855O form
One CMS-855O application will enroll a provider into nationwide program and carries over between all states
- One CMS-855O application will enroll a provider into nationwide program and carries over between all states
Last Updated Thu, 13 Feb 2020 15:21:39 +0000