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 [...]

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 [...]

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 [...]

CMS-855I Completion Tips for Managing Employee Information in Section 6

CMS-855I Completion Tips for Managing Employee Information in Section 6 Table of Contents Section 6: Managing Employee Information Instructions for Completing Section 6 Section 6A ‒ Managing Employee Identifying Information Section [...]

CMS-855I Completion Tips for Physicians and NPPs that Reassign All Benefits Revalidation Application

CMS-855I Completion Tips for Physicians and NPPs that Reassign All Benefits Revalidation Application Follow the instructions printed on the CMS-855I application and refer to this list of sections required for revalidation. Sections [...]

CMS-855O Completion Tips for Physicians or Eligible Professionals for the Sole Purpose of Ordering, Certifying or Prescribing Part D Drugs

CMS-855O Completion Tips for Physicians or Eligible Professionals for the Sole Purpose of Ordering, Certifying or Prescribing Part D Drugs CMS-855O is a national enrollment; providers who relocate to another state are not required to disenroll [...]

CMS-855B Completion Tips for Clinics/Group Practices and Other Suppliers Revalidation Application

CMS-855B Completion Tips for Clinics/Group Practices and Other Suppliers Revalidation Application Follow the instructions printed on the CMS-855B application and refer to this list of sections required for revalidation. Section [...]

Resolving PECOS Common Errors and Warnings

Table of Contents Error/Warning PECOS Reference Guide and Help Desk Information [Return to Top] Error/Warning Error indicated, correct all topic errors Warning indicated, verify information for accuracy PECOS Topic [...]

Understanding Participating, Nonparticipating and Opt Out Status

Understanding Participating, Nonparticipating and Opt Out Status Principles Participating Status Nonparticipating Status Opt Out Status Explanation When a physician/practitioner enrolls as a new provider in [...]

Medicare Provider/Supplier Specialty Codes

Medicare Provider/Supplier Specialty Codes Here is the list of Medicare provider/supplier specialty codes you can use as a reference during the enrollment process. Code Description 01 General practice 02 [...]

Medicare Provider/Supplier Provider Type Codes

Medicare Provider/Supplier Provider Type Codes Below is the list of Medicare provider/supplier type codes you can use as a reference during the enrollment process and claims processing. Code Description 20 [...]

CMS-855B Completion Tips for Ownership Interest and/or Managing Control Information

CMS-855B Completion Tips for Ownership Interest and/or Managing Control Information Table of Contents Section 5 – Ownership interest and/or managing control information Instructions for Completing Section 5 Section 5A - [...]

Supporting Documentation Required for Enrollment Revalidations

Supporting Documentation Required for Enrollment Revalidations Submit all required documentation based on your revalidation scenario: Written confirmation from the IRS confirming your legal business name and EIN (e.g., IRS CP-575) The [...]

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an email containing a Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: NGS-PE-Communications@elevancehealth.com containing the NGS case number for tracking [...]

CMS-855I Completion Tips for Physicians and NPPs in Private Practice (Sole Owner or Sole Proprietor) Revalidation Application

CMS-855I Completion Tips for Physicians and NPPs in Private Practice (Sole Owner or Sole Proprietor) Revalidation Application Follow the instructions printed on the CMS-855I application and refer to this list of sections required for [...]

Description of Revalidation

Description of Revalidation Section 6401(a) of the Affordable Care Act requires that all enrolled providers or suppliers revalidate their Medicare enrollment information under new enrollment screening criteria. To maintain Medicare billing [...]

Revalidation Request Mailed

Revalidation Request Mailed We will mail the revalidation notices to identified providers and suppliers currently enrolled in the Medicare Program. The revalidation notice will be sent two to three months prior to due date. Each provider or [...]

How Will You Know it is Time to Revalidate

How Will You Know it is Time to Revalidate We will contact each provider or supplier when it is time to revalidate their enrollment information by sending a revalidation notice with a revalidation due date.   We will send the [...]

How to Search on the Medicare Revalidation List Tool for Due Date

How to Search on the Medicare Revalidation List Tool for Due Date Table of Contents How to Search on the Medicare Revalidation List Tool for Due Date Find a Provider By NPI By Name Associated Datasets [Return to Top] How [...]

Cognitive Assessment

Cognitive Assessment Table of Contents Billing Codes Billing Information Documentation Related Content [Return to Top] Billing Codes 99483: 60 minute face-to-face [Return to Top] Billing Information Cognitive assessment [...]

May 2023

In This Issue National Government Services Articles for Part A and Part B Providers Change in Pricing for Electroencephalogram Long-Term Monitoring Effective 4/1/2023 EDI Enrollment Spotlights Top Rejections Tobacco Cessation [...]

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 [...]

Clinics/Group Practices and Other Suppliers

Clinics/Group Practices and Other Suppliers Download CMS-855B. Complete Sections: 1, 2, 3, 4, 5, 6, 8, 12, 13, 15B and D (if applicable) Attachment 1 for Ambulance Suppliers Attachment 2 for IDTFs Attachment 3 for OTP Notes [...]

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 7/31/2024

Reviewing the PECOS Enrollment Practice Location Area for OPPS Providers Claim Submission

Reviewing the PECOS Enrollment Practice Location Area for OPPS Providers Claim Submission All off-campus OPPS locations must be identified on the enrollment record. If a hospital OPPS claim is submitted with a practice service location that [...]

Advanced Care Planning

Advanced Care Planning Table of Contents Billing Codes Billing Information Documentation Related Content [Return to Top] Billing Codes 99497: 30 minutes 99498: each additional 30 minutes [Return to Top] Billing Information [...]

Behavioral Health Integration

Behavioral Health Integration Table of Contents BHI Overview Eligible Conditions Part B Billing/Coding BHI Services New Coding and Payment for BHI Conditions Billed by Clinical Psychologists and Clinical Social Workers Initiating [...]

Chronic Care Management

Chronic Care Management Table of Contents Billing Codes Billing and Documentation Care management for chronic conditions Related Content [Return to Top] Billing Codes 99490: Provide at least 20 minutes of clinical staff time [...]

Principal Care Management

Principal Care Management Table of Contents Billing Codes Documentation Related Content [Return to Top] Billing Codes 99424: PCM services for a single high-risk disease first 30 minutes provided personally by a physician or [...]

Psychiatric Collaborative Care Model

Psychiatric Collaborative Care Model The psychiatric CoCM was introduced in 2018 and Medicare began making separate payments using CPT codes 99492, 99493 and 99494. Effective 1/1/2021, G2214 was added to Psychiatric CoCM to cover shorter [...]

Hospice Notice of Election Termination/Revocation (Type of Bill 8xB)

Hospice Notice of Election Termination/Revocation (Type of Bill 8xB) Table of Contents Hospice Notice of Election Termination/Revocation Examples of NOTR Time Frames Reminders/Notes on the NOTR Correcting a Discharge Date on an [...]

Medicare University Right Content

Helpful Resources Log into MU Sign up for Email Updates

Procedure Code 99211 Job Aid

Procedure Code 99211 Job Aid Table of Contents Definition for 99211 Definition for Established Patient Face-to-Face Encounter Requirements Presence of Physician Requirements Evaluation and Management Services Provider-Patient [...]

Resources for Medicare Providers of Service

Resources for Medicare Providers of Service Access to all resources and tools offered to our Medicare provider and supplier communities  

Hospice Documentation Checklist

Hospice Documentation Tips

Hospice Documentation Tips Medicare coverage of hospice depends on a physician’s certification that an individual’s prognosis is a life expectancy of six months or less if the terminal illness runs its normal course. It is important that the [...]

Implementation of the Election Statement Addendum

Implementation of the Election Statement Addendum Hospice Election Statement Addendum Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, the beneficiary must be entitled to [...]

Tips for Responding to a Hospice ADR

Tips for Responding to a Hospice ADR National Government Services performs medical review audits of services billed to Medicare to validate that the documentation supports coverage and level of services billed. If one of your claims is [...]

General Inpatient Check Off List

Documentation Requirements for the Medicare Hospice Election Statement

Documentation Requirements for the Medicare Hospice Election Statement Election of Hospice Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, the beneficiary must be entitled [...]

Incident to Office Guidelines

“Incident to” Office Guidelines The CMS rules for billing office services as “incident to” a physician’s services are summarized within this document. Of note, the concept does not apply to services performed in the hospital environment, which [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

August 2024

In This Issue National Government Services Articles for Part A and Part B Providers LCD and Article Updates for June/July 2024 [Cancelled] Multijurisdictional Contractor Advisory Committee Meeting Notice on Superficial Radiation Therapy [...]

Part B Top Claim Errors Updated

Part B Top Claim Errors Updated Using data analysis, we update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you can take to [...]