Provider Enrollment Appeals Process

Provider Enrollment Appeals Process Table of Contents Provider Enrollment Appeals Process Corrective Action Plans Requirements for CAP Submission Reconsiderations Requirements for Reconsideration Request Submission Related Content [...]

Rebuttal for Deactivation of Medicare Billing Privileges

Rebuttal for Deactivation of Medicare Billing Privileges Pursuant to 42 CFR, Section 424.545(b), a provider or supplier whose Medicare billing privileges have been deactivated may file a rebuttal in accordance with 42 CFR, Section 405.374. A [...]

Rebuttal for Deactivation of Medicare Billing Privileges

Rebuttal for Deactivation of Medicare Billing Privileges Pursuant to 42 CFR, Section 424.545(b), a provider or supplier whose Medicare billing privileges have been deactivated may file a rebuttal in accordance with 42 CFR, Section 405.374. A [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction 6 HH+H Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Home Health Services - Medical Necessity ICD-10 Z47-Z47.89 N/A 55H3V– The documentation did [...]

Meeting Schedules

Meeting Schedule Part A POE AG Meetings for Jurisdiction 6 and Jurisdiction K J6: Illinois, Minnesota, Wisconsin and Federally-Qualified Health Centers in All States JK: Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island [...]

837D Edit Spreadsheet

837D Edit Spreadsheet

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Approval Pending Regional Office Review

Approval Pending Regional Office Review For ASC and PXRS: When credentialing, you will receive an approval pending regional office review status in PECOS, if there is a change processed that requires a tie-in notice (Centers for Medicare [...]

Approval Pending Regional Office Review

Approval Pending Regional Office Review For ASC and PXRS: When credentialing, you will receive an approval pending regional office review status in PECOS, if there is a change processed that requires a tie-in notice (Centers for Medicare [...]

National Government Services Will Send Email Updates from a New Email Address Beginning 8/7/2024

National Government Services Will Send Email Updates from a New Email Address Beginning 8/7/2024 Starting 8/7/2024, National Government Services will send email updates to you from a new email address, noreply@noreply.ngsmedicare.com instead [...]

MLN Connects® Newsletter: July 25, 2024

MLN Connects® Newsletter: July 25, 2024 News CMS Announces Resources & Flexibilities to Assist with Public Health Emergency in Texas CMS Oral Health Cross-Cutting Initiative Fact Sheet Doctors & Clinicians: Utilization Data on [...]

Counseling to Prevent Tobacco Use and Tobacco Related Diseases Job Aid

Calculating the Batch Receipt Date

Calculating the Batch Receipt Date When a file is received in the EDI Gateway, the date and time received are applied as the receipt date of the claim(s).  A business day is considered 12:00 a.m. to 4:59:59 p.m. ET Monday through Friday. [...]

Health Benefits of Quitting Smoking and Helping Your Patients Kick the Habit

Health Benefits of Quitting Smoking and Helping Your Patients Kick the Habit Smoking leads to multiple diseases and potentially death, but it is preventable! Anyone at any age can benefit from quitting smoking. Medicare covers tobacco [...]

CMS Links

  Accreditation of Advanced Diagnostic Imaging Suppliers All Fee-For-Service Providers Ambulatory Surgical Centers (ASC) Center Beneficiary Notices Initiative (BNI)  Care Management including: Advanced Care Planning Behavioral [...]

LCD and Article Updates for August 2024

LCD and Article Updates for August 2024 Articles L33394/A52423 – Drugs and Biologicals Provided off-label coverage of Infliximab for microscopic colitis and retirement of Bortezomib article, effective 8/1/2024. The article has been revised to [...]

How to Submit a Hardship Request

How to Submit a Hardship Request To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be [...]

How to Obtain a Refund

How to Obtain a Refund A refund will only be granted in the following instances: The application fee was not required for the application submitted A hardship request was subsequently approved and a fee was paid An application was [...]

Paper Enrollment Process

Paper Enrollment Process Paper-based enrollment applications are available. Submitting your enrollment via paper is an option, but PECOS is the preferred method to process the application with streamlining features. Determine which CMS 855 [...]

For First Time Users: Request a User ID and Connection

For First Time Users: Request a User ID and Connection Instructions for accessing PECOS: If you are unsure if you have a user ID, select “Forgot User ID?” from PECOS. Connect to the Identity & Access (I&A) Management [...]

Make Necessary Changes to the Existing Enrollment In PECOS

Make Necessary Changes to the Existing Enrollment In PECOS Instructions for accessing and submitting existing enrollment information in PECOS: Login to PECOS Select My Associates Scroll down under Existing Associates Select “View [...]

Review and Update All Topics

Review and Update All Topics Instructions for making changes to your PECOS enrollment topics: Select the ‘Topic View’ tab and verify information in every topic Note: EFT topic must be completed by: groups suppliers sole owner group [...]

Upload Supporting Documents

Upload Supporting Documents Instructions for PECOS to upload required supporting documentation: Select the ‘Topic View’ tab Select “Required and/or Supporting Documents” Upload documents Mandatory for all provider/supplier types: [...]

Resolve All Errors and Verify Warnings

Resolve All Errors and Verify Warnings Instructions for resolving all errors and warnings: Select the ‘Errors/Warning Check’ Tab. Correct all errors identified and verify any warnings. Related Content Resolving PECOS Common Errors and [...]

Sign and Submit the Application(s)

Sign and Submit the Application(s) In order to send your application, after resolving all errors, you must select “Begin Submission” which is available from any of the tabs (Topic View, Fast Track View, Error/Warning Check). Instructions for [...]

Verify and Manage Signature(s)

Verify and Manage Signature(s) Verify signatures on all application(s) submitted including applications that were “Return for Corrections”, by returning to the enrollment box in PECOS. Important: The reassignments are viewed by selecting [...]

Physicians or Nonphysician Practitioners With/Without Private Practice

Physicians or Nonphysician Practitioners With/Without Private Practice Download CMS-855I. Complete the CMS-855I section 1A by selecting “You are reporting a change to your Medicare enrollment information,” then in section 1B, check all that [...]

Provider Clinics/Group Practices and Other Suppliers

Provider Clinics/Group Practices and Other Suppliers Download CMS-855B. Complete the CMS-855B section 1A by selecting “You are reporting a change to your Medicare enrollment Information,” then in section 1B, check all that apply and [...]

Supporting Documents

Supporting Documents Attach required supporting documentation for individuals or organizations. Submit applicable documents. CMS-588 EFT Authorization Agreement and voided check or bank confirmation letter IRS document confirming your [...]

Supporting Documents

Supporting Documents Attach required supporting documentation for individuals or organizations. Submit applicable documents: CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement and voided check or bank confirmation letter IRS [...]

Electronic Funds Transfer Agreement

Electronic Funds Transfer Agreement Download and complete the CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement. Physicians and nonphysician practitioners who are reassigning all of their payments to another entity are not [...]

Verify and Manage Signature(s)

Verify and Manage Signature(s) Verify signatures on all application(s) submitted including applications that were “Return for Corrections”, by returning to the enrollment box in PECOS. Important: The reassignments are viewed by selecting [...]

Resolve All Errors and Verify Warnings

Resolve All Errors and Verify Warnings Instructions for resolving all errors and warnings: Select the ‘Errors/Warning Check’ Tab.  Correct all errors identified and verify any warnings.   Related Content: Resolving PECOS [...]

Upload Supporting Documents

Upload Supporting Documents Instructions for PECOS to upload required supporting documentation: Select the ‘Topic View’ tab Select “Required and/or Supporting Documents” Upload documents Mandatory for all provider/supplier types: [...]

Review and Update All Topics

Review and Update All Topics To access PECOS Topics: Select the ‘Topic View’ tab and verify information in every topic Note: EFT topic must be completed by groups, suppliers, incorporated sole owners’ group enrollment and individuals’ [...]

Revalidate Enrollment In PECOS

Revalidate Enrollment In PECOS Instructions for accessing and submitting existing enrollment information in Provider Enrollment, Chain and Ownership System (PECOS): Login to PECOS Select My Associates Scroll down under Existing Associates [...]

For First Time Users: Request a User ID and Connection

For First Time Users: Request a User ID and Connection Instructions for accessing PECOS: If you are unsure if you have a user ID, select “Forgot User ID?” from PECOS. Connect to the Identity & Access (I&A) Management [...]

Report Changes to your Enrollment Records

Report Changes to your Enrollment Records You must report changes of information in your Medicare enrollment records within 30 days for: Change(s) in ownership or control, including changes in authorized officials(s) Change(s) in practice [...]

Terminating (Dissolving) Practice and/or Retiring

Terminating (Dissolving) Practice and/or Retiring Terminating Sole-Owned or Sole-Proprietor Practice and Retiring Download CMS-855I. Complete sections 1A, 2A, 13 and 15B (update addresses in 2D, 2E, 4B, 4C). Terminating Practice ONLY [...]

Ordering and Referring Provider

Ordering and Referring Provider Download CMS-855O. Complete section 1A and follow instructions. Reviewed 7/29/2024

View Existing Medicare ID (PTAN) in PECOS and Effective/End Dates for Reassignment

View Existing Medicare ID (PTAN) in PECOS and Effective/End Dates for Reassignment Important: If you recently submitted an application to request a PTAN, please verify the approval letter was received prior to submission of claims. Log into [...]

Legal Business Name Match

Legal Business Name Match Medicare enrollment success starts with you. It is vital that any time you are asked to supply your LBN or legal name, you indicate the name exactly as it appears at the IRS or the Social Security Administration [...]

Participating Status on Provider Enrollment Approval Letters

Participating Status on Provider Enrollment Approval Letters If the Medicare Participating Physician or Supplier Agreement (CMS-460) is not submitted during initial enrollment or during the annual participation open enrollment period, the [...]

Instructions for Unfinished PECOS Enrollment Application(s)

Instructions for Unfinished PECOS Enrollment Application(s) Table of Contents Instructions for Unfinished PECOS Enrollment Application(s) Instructions For Unfinished PECOS Applications Instructions For Application Status “Pending [...]

PECOS Correct and Resubmit Application Instructions

PECOS Correct and Resubmit Application Instructions Login to PECOS and select the following:    My Associates View Enrollment for applicable enrollment under Existing Associates Correct and Resubmit for [...]

Provider Enrollment Application Process Timeline

Provider Enrollment Application Process Timeline All MACs, including National Governments Services, have a goal to finalize an Internet-based PECOS application within 15 days and a CMS-855 paper application within 30 days, if all required [...]

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment Reminder, if a hospital, clinic/group or Independent Diagnostic Treatment Facility has ADI screening equipment, certification from a designated ADI accrediting [...]

PECOS Application Status Tool

PECOS Application Status Tool The status of your application is indicated by the step that is highlighted. If an application fee is required, an additional step will be added and the system will generate 5 steps. Your application was [...]

Information for Physicians Who Refuse to Enroll, Opt-Out of the Medicare Program, or Submit Claims to Medicare

Information for Physicians Who Refuse to Enroll, Opt-Out of the Medicare Program, or Submit Claims to Medicare We have received inquiries asking whether physicians may refuse to enroll in Medicare and refuse to submit claims to Medicare when [...]

Revalidation Application Checklist

Revalidation Application Checklist Use the Revalidation Application Checklist to assist when revalidating your enrollment information. The general checklist will allow you to understand requirements while the PECOS and CMS-855 paper checklist [...]

Issues with Medicare Beneficiary Submitted Claims - We Need Your Help

Issues with Medicare Beneficiary Submitted Claims ‒ We Need Your Help Table of Contents Issues with Medicare Beneficiary Submitted Claims ‒ We Need Your Help Summary of Beneficiary Submitted Claims Related Content NGS Provider [...]

Introducing PECOS 2.0

Introducing PECOS 2.0 PECOS 2.0 will make the Medicare enrollment and revalidation processes faster and more efficient.  For more information, visit Introducing PECOS 2.0. Revised 7/29/2024

Understanding Authorized Official and Delegated Official Roles

Understanding Authorized Official and Delegated Official Roles Table of Contents Understanding Authorized Official and Delegated Official Roles Medicare Enrollment Records CMS Identity and Access Management System [Return to Top] [...]

Change of Tax ID Instructions and Forms

Change of Tax ID Instructions and Forms Table of Contents Certified Providers and Certain Other Suppliers Clinics/Group Practices Sole Owner/Sole Proprietor Effective Dates When Changing a Tax ID For Clinics/Group Practices [Return [...]

Ordering and Referring Points of Interest

Ordering and Referring Points of Interest Per MLN SE18008, MACs will process CMS Form-855O provider enrollment applications submitted for unlicensed residents if the application submission includes either: A residency contract signed and [...]

MSP Payment and Savings Calculator Bottom

How to Determine the Medicare Secondary Payment Amounts First, the MSP payment is determined by the following: Actual charge by physician/supplier or OTAF minus amount paid by primary Usual Medicare payment determination  Fee [...]

Adding or Terminating a Reassignment to an Established Group

Adding or Terminating a Reassignment to an Established Group Table of Contents Adding Reassignment Terminating Reassignment (By Individual) Terminating Reassignment (By Organization) Terminating Physician Assistant Employment Arrangement [...]