Medicare enrollment is required for institutional providers that plan to furnish services to Medicare beneficiaries. Providers must confirm their enrollment type, submit the appropriate application and supporting documentation, and complete any applicable certification requirements before billing Medicare.

• Before You Begin
• Enrollment Types Noridian Does Not Handle
• How to Apply
• Processing Timeframes
• After You Apply

Before You Begin

Successful Medicare enrollment begins with proper preparation. Providers should first review the Enrollment for Specialties information to confirm the correct enrollment type and identify any provider-specific requirements. Depending on the provider type, enrollment may require state licensure, a survey, accreditation, certification, an application fee, or CMS approval.

All applicants using the CMS-855A must obtain a Type 2 organizational National Provider Identifier (NPI). Create an account through the Identity & Access Management System, then use the same credentials to access the National Plan and Provider Enumeration System (NPPES) and the Provider Enrollment, Chain and Ownership System (PECOS). Apply for the Type 2 NPI through NPPES and keep the organization's NPI information current.

Before starting the application, verify that the organization's legal business name, Taxpayer Identification Number, address, taxonomy, ownership information, and other identifying information match the supporting records. Gather the documentation required for the provider type and enrollment action, which may include IRS records, state licenses, accreditation or certification information, ownership and managing-control information, organizational documents, and banking records.

Enrollment Types Noridian Does Not Handle

Noridian does not process all institutional enrollment types, even when the provider is located within a Noridian jurisdiction. Noridian does not process applications for histocompatibility laboratories, Indian Health Service facilities, Organ Procurement Organizations, or Religious Non-Medical Health Care Institutions.

Use the CMS Who Are the MACs resource to identify the organization responsible for processing the application. These providers may use the CMS-855A even though Noridian does not process their applications.

How to Apply

Providers may submit Medicare enrollment applications electronically through PECOS or by using the current paper CMS-855A. Institutional providers use the CMS-855A to enroll in Medicare or update existing enrollment information.

PECOS is the recommended method because it allows providers to complete the application, upload supporting documentation, sign the certification statement, and submit the application electronically. After submission, PECOS generates a receipt with a web tracking number. Providers should retain this number for future reference. Supporting documentation for a PECOS application must be uploaded through PECOS and should not be mailed separately unless Noridian requests it.

Providers who cannot apply electronically must complete the current CMS-855A available from the Part A Enrollment Forms webpage. Send the completed application and all required supporting documentation to the appropriate Noridian mailing address. After Noridian receives the application, the provider will receive an acknowledgment letter containing an application reference number.

Processing Timeframes

The time required to process a Medicare enrollment application varies based on the submission method, the provider type, and whether additional approval is required.

These timeframes cover Noridian's review before referral to the State Agency or CMS when additional approval is required. They do not represent the total time needed to complete enrollment and certification.

Some initial enrollments and changes of ownership require State Agency, accrediting organization, or CMS review. There is no standard timeframe for these reviews after Noridian makes its recommendation. Missing information, requests for clarification, screening activities, site visits, surveys, and provider-specific requirements may extend the overall process.

After You Apply

After receiving the application, Noridian reviews the enrollment information and supporting documentation. If information is missing or requires clarification, Noridian will contact the individual identified on the application. Providers must respond by the deadline stated in the request to prevent additional delays or an adverse application decision.

Provider types subject to certification may require a State Agency or approved accrediting organization survey and CMS approval. CMS makes the final program-eligibility decision for certified providers. If approved, the provider may also need to sign a provider agreement.

Once all applicable requirements are satisfied, the provider will receive written notification of the enrollment decision. The approval notice includes the effective date, Provider Transaction Access Number when applicable, and any additional instructions. Providers should review the approval notice before submitting Medicare claims and should not treat receipt of a PTAN by itself as authorization to bill.

Approved providers must also complete applicable Electronic Data Interchange enrollment, confirm Electronic Funds Transfer information, and establish access to the appropriate Medicare billing systems before submitting claims.

Providers must keep their enrollment information current and report changes within the CMS timeframe that applies to the provider type and change. Submit updates through PECOS or the appropriate CMS-855A transaction.