Open Enrollment

On an annual basis the government gives providers the opportunity to either become a Medicare Participating Supplier or to discontinue the participation. The annual period typically is 45 days long and generally begins in mid-November. The effective date standardly is January 1st. There may be circumstances where this process is delayed due to an enactment from Congress. The participation or non-participation status remains effective through December 31 of each year. The status will renew automatically for the next 12-month period. If a provider would like to become non-participating during this timeframe a written notice is necessary. Include legal name, social security number and national provider identifier (NPI).

Annually a postcard will be mailed to remind the provider community of the Open Enrollment period. If you are uncertain of the status of business, log into PECOS Web, to check your enrollment participation status. If changing status, all billing should be held until notified of the status change. Noridian is not able to reprocess 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 Thu, 03 Jun 2021 14:16:21 +0000