Provider Enrollment: Reduce Development Requests for Additional Action
In an effort to reduce the request of additional information and/or documentation on provider enrollment applications, verify all required actions are complete prior to submission, if applicable.
Here are reminders for processing to be efficient:
- Verify NPI legal name in NPPES
- Verify CMS-588 is complete and include a voided check or bank confirmation letter
- Submit correct application:
- Initial enrollment
- Individual (reassigning benefits, sole proprietor, sole owner)
- Paper or PECOS CMS-855I
- Individual (reassigning benefits, sole proprietor, sole owner)
- Revalidation
- Individual reassigning benefits, sole proprietor
- Paper or PECOS CMS-855I
- Individual sole owner
- Paper CMS-855I
- PECOS both the CMS-855I and CMS-855B enrollments
- Individual reassigning benefits, sole proprietor
- Initial enrollment
- Certified providers (institutional providers and select certified Part B entities) are required to pay an application fee for:
- Initial enrollment
- Revalidation
- Change of information adding a new practice location
If you are not sure you are a certified provider and need to pay the fee, use the Medicare Provider Enrollment Application Fee Decision Tree Tool located on our website under Resources then Tools & Calculators.
- Individual Control section in PECOS and section 6 on the CMS paper application require information and/or roles for AO/DO (e.g., Title, SSN, DOB, % of ownership) as well as for the specialty enrollment Hospice/SNF identify all medical directors/administrators.
- Appropriate authorized and/or delegated official signature and date on the provider enrollment application is a requirement, which includes the signature and date from individual providers.
- CMS paper applications/forms – verify signatures and dates are present before mailing application. Any newly added authorized or delegated official must sign and date application.
- PECOS electronic applications/forms – log back into PECOS within 24 hours after submission to verify all signatures are in the complete status. If still pending, either upload the signed and dated certification statement for each required signature or resend the email to notify signer to e-sign. The certification statement can only be uploaded into PECOS on the manage signature screen and should not be mailed or faxed.
If you have questions about verifying signatures in PECOS, please join our next webinar titled, PECOS: Manage Signatures and Additional Information Requests by registering for this session on our website under Events.
- Submit required supporting documents based on application type:
- IRS documentation
- DEA certificate
- Voided check and/or bank confirmation letter with CMS-588
- No-physician degree/certification
- Exhibit 177 (FQHC only)
- Copy(s) of all bills of sale or sales agreements (CHOWS, Acquisition/Mergers, and Consolidations only)
- Copy(s) of all documents that demonstrate meeting capitalization requirements (HHAs only)
Revised 6/12/2024