Enroll in Medicare
Before jumping into Medicare Enrollment applications, it is best to be prepared. To ensure a provider has everything necessary to properly complete a Medicare application(s), check out the below table. Not all topics may apply to each applicant.
- Prepare and Get Started
- Participating versus Non-Participating status
- Required Applications and Tips
- What a Provider Should Expect After Application Submission
View Enrollment related terms on the Terms and Definitions webpage.
* Required for all applicants
|* Is Provider Eligible to Enroll in Medicare?|| |
|*Obtain NPI via NPPES as it is required for all providers/suppliers * If Eligible, enroll as Group Member, Organization, Sole Owner, or a Sole Proprietor?|| |
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
To further help explain the differences, watch our How Do I Determine What I Am? Tutorial.
Individual providers must obtain a Type 1 (Individual) NPI.
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.|
|PECOS||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 I&A, 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 provider 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 the 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 the Nonparticipation webpage
|* Have Supporting Documents Available|| Examples |
Required Applications and Tips
Providers may submit applications in one of two ways.
- 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
- Enrollment on Demands (EoDs) - Step-by-step self-paced tutorial to help providers complete an application. For more information, view the Enrollment on Demand (EoD) Tutorials for Part B Specialties webpage.
|Provider Type||Required Application(s)||Tips|
|Group Member|| || |
|Organization|| || |
If provider not enrolled, submit CMS-855I and CMS-855R
If provider is actively enrolled, submit CMS-855R
|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 regarding 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
What a Provider Should Expect After Application Submission
|Application Type||Processing Time with an Onsite Visit||Processing Time without an Onsite Visit|
|PECOS||It can take 80-120 calendar days before application is completed||It can take 45-90 calendar days before application is completed|
|Paper||It can take 80-210 calendar days before application is completed||It can take 60-180 calendar days before application is completed|
- When a provider application is completed, a notification letter will be sent. Letter will state whether application has been approved, rejected or denied
- Corrections or additional information may be required to complete the processing of an application. Requests will be sent to contact person on application, if provided. Information must be submitted within 30 days of date of request
- A PTAN will be issued and shown on approval letter. See Provider Transaction Access Number (PTAN) webpage for details
Provider may begin billing:
- Enroll with Electronic Data Interchange (EDI) to bill electronically, visit EDISS for more information. Select state you are enrolled in
- If there are any changes that must be made to enrollment following approval, complete a new form with any changes within 30 days to avoid revocation
CMS requires providers/suppliers to revalidate every five years. View the Revalidation webpage for details.
Last Updated May 18, 2018