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Provider Enrollment: Top Reasons Behind Delays in Processing the Application

Medicare enrollment plays a vital role in ensuring compliance with CMS requirements. To help streamline the process and achieve the best results, it's important to submit all necessary information and documentation with your enrollment application, whether electronically in PECOS or on the paper CMS-855. By focusing on the details of your application type and verifying information carefully, you can enjoy a quicker and more efficient processing experience.

Below are common reasons for development

Reason Resolution
Incomplete Signature and Date Verify the Authorized and/or Delegated Officials signs and dates the application, including any newly added AO/DO.
Missing dependent CMS-855I application(s)

CMS-855B needs dependent CMS-855I application:

Missing dependent CMS-855B application

CMS-855I needs dependent CMS-855B application:

  • Individual reassigning to an entity that is not enrolled
  • PECOS submission for updates to a sole owned entity’s enrollment information
NPPES name mismatch NPPES website information must match for the NPI enrollment submission
Missing required supporting documents

Depending on the enrollment specialty and type of application submitted examples are:

  • Diploma and National Board Certification for a nonphysician
  • State Temporary License
  • DEA
  • IRS (CP575, CP147c, SS-4) identifying current legal name and TIN/EIN
  • Voided check or bank confirmation letter with submission of the CMS-588

Review the articles Supporting Documents and/or Eligible Nonphysicians for assistance

Missing or Incorrect CMS-588 EFT information

Verify all fields are complete and accurate Legal name on the bank account (void check/bank confirmation letter) must match:

  • SSA office for the individual biller
  • IRS document for the sole proprietor using an EIN
  • IRS document for the entity

 

Resources on our website to assist with application submission:

Revised 3/17/2025