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Top Tips for Medicare Provider Enrollment

Top Tips for Medicare Provider Enrollment

Enrolling providers with Medicare can be a tedious, time-intensive process. However, the process takes even longer if the application is incomplete or contains the wrong information. Whether you are new to Medicare enrollment or have been enrolling providers for years, here are a few reminders to help make the process go more smoothly.

First, remember that all Medicare enrollment applications require a National Provider Identifier (NPI). If you are submitting for a physician or practitioner, use the type 1 NPI. If you are submitting for a clinic, group, facility, organization, or supplier, use the type 2 NPI.

Second, all the information you provide on the provider enrollment application must match exactly to the CMS National Plan and Provider Enumeration System (NPPES). For individual physicians or practitioners, the individual name must match the Social Security Administration (SSA) files. (NOTE: Medicare enrollment does not accept nicknames in NPPES.) For clinics, groups, facilities, organizations, or suppliers, the name must match the Internal Revenue Service’s paperwork, including LLC, INC, PC, or other designation. (NOTE: Do not use a Doing Business As name.)

Third, if NPPES does not currently match the information on your provider enrollment application, update NPPES before submitting the application.

Finally, be sure to fill out the provider enrollment completely before submitting and sign the application electronically within 24 hours, if you chose that option. CMS requires Medicare Administrative Contractors to process all provider enrollment applications upon receipt. By the time you notice a missing signature or NPI, your MAC will have already begun development for the missing information, which could mean delays to your application. 

For more information about Medicare provider enrollment, check out Indiana MAC WPS-GHA’s Provider Enrollment Guides and Resources webpage. You can also register for two upcoming provider enrollment webinars, offered for free through the WPS-GHA Learning Center:

  • “Completing the CMS Form 855B”—November 20, 2019, 11AM-12PM ET. Do you have questions about completing the CMS Form 855B – Medicare Enrollment Application for Clinics, Group Practices and Certain Other Suppliers? This training will be a live demonstration of completing the form. The training covers: a live walk-through of the form, tips for completing the form, and common errors causing development .
  • “Completing the CMS Form 855I”—December 18, 2019, 11AM-12PM ET. Do you have questions about completing the CMS Form 855I – Medicare Enrollment Application for Physicians and Non-Physician Practitioners? This training will be a live demonstration of completing the form. The training covers: a live walk-through of the form, tips for completing the form, and common errors causing development.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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