Total Enrollment: Provider Enrollment

Provider Enrollment (PE) is the cornerstone of Medicare reimbursement. It's not just paper work to fill out or an online application to complete, it is vitally important that the enrollment is set-up correctly to receive funds back quickly. PE is given direction on how to complete an application and what supporting documentation is required. See CMS Internet Only Manual (IOM), Publication 100-08, chapter 10. If at any time questions arise about the information below, reference this guide.

To begin the Total Enrollment process, follow the steps below.

Step 1: Apply for a National Provider Identifier (NPI)

  • Apply for a NPI. Complete on National Plan and Provider Enumeration System (NPPES)
    • Helpful hint: Write down user name and password that set-up with this site. This will be needed later in PE process
  • While applying for an NPI, a type 2 (organizational) NPI is required

Step 2: Complete an Application

Now that an NPI has been obtained, complete an enrollment application. There are two ways that this can be done.

  1. Provider Enrollment, Chain and Ownership System (PECOS)
    • Use same user name and password that was created to apply for an NPI to log into PECOS
    • How long can it take for the application to be completed?
      • A PECOS application, without an onsite visit, may take 15-50 calendar days before it is sent to state for approval
      • A PECOS application, with an onsite visit, may take 50-85 calendar days before it is sent to state for approval
        • Helpful hint: An onsite visit is where a site inspector comes to a practice location to verify that it a functioning place of business
      • To see more PECOS benefits, visit the PECOS webpage
  2. Paper Application
    • Access paper application on Enrollment Forms webpage
    • How long can it take for an application to be completed?
      • A paper application, without an onsite visit; may take 30-65 calendar days before it is sent to state for approval
      • A paper application, with an onsite visit; may take 65-100 calendar days before it is sent to state for approval
    • Effective dates are set/approved by CMS
    • After Noridian has reviewed application, letter is sent to application contact or state advising of one of the following:
      • Approval Recommended: Application forwarded to CMS and state for approval
      • Rejected: Provider must start over with new application, new signatures, etc, as all information was not provided as requested
      • Denied: Provider does not meet Medicare qualifications and was not enrolled. Denial letter will provide appeal instructions
      • Returned: Application returned without review to provider for specific reasons

Helpful hint: Unsure about allowed provider/supplier specialties? See the CMS Publication 100-04, chapter 26, sections 10.8 through 10.8.3

Step 3: Supporting Documentation Submission

Common items that are required to be submitted as supporting documentation.

  • If enrolling with a Tax Identification Number (TIN) or Employee Identification Number (EIN), a copy of number on an IRS generated letterhead must be submitted
    • CP575 or 147C are most common forms of document
  • Electronic Funds Transfer (EFT) is mandatory when signing up with Medicare. This only applies to new organizations, sole proprietors, and sole owners
    • A 588-EFT form must be filled out if completing a paper form
    • If completing application via PECOS, CMS-588 EFT is included with application. A paper version is not necessary
    • A voided check or a bank letter signed by a manager must be submitted
      • Helpful hint: Name on bank account must match what is on IRS document

Step 4: Application Help Available

  • To help providers complete application(s), view step-by-step video tutorials (Enrollment on Demand (EoD)). Access EoDs from Enrollment on Demand webpage
    • Help hint: Viewers may pause tutorials at any time to complete a section or topic

Step 5: Check Application Status

  • View status of application on Enrollment Application Status Search
  • Must enter Application/Reference Number or Web Tracking ID to view when it was received, if it is in progress or if something is necessary to continue processing

Step 6: Tie-in Notice

  • CMS will issue an approval letter (tie-in notice) once application is approved. Enrollment record is not final until approval from CMS (tie-in notice) is processed by Medicare Administrative Contractor (MAC)
    • If an additional onsite is not required, this process may take up to 21 calendar days
    • If an additional onsite is required, this process may take up to 45 calendar days

Step 7: Application Completed


Last Updated Thu, 27 May 2021 16:37:15 +0000