Provider Enrollment: Submitting Claims Before the Effective Date

National Government Services has noticed an increase of Part B claim submissions from Medicare enrolled group practices for rendering providers prior to receiving their approval for enrollment and earlier than their effective date allowed.

Individual physicians and nonphysician practitioners, who reassign benefits or have employment arrangements with an individual or group practice, need to be assigned a PTAN by NGS to connect to the billing provider before submitting claims for payment.

The submission of a claim should be after the CMS-855 application was submitted and the provider enrollment approval letter is received identifying the allowed effective date. The action of not verifying receipt of the approval letter and effective date prior to the claim submission will cause the provider to be liable for the claim and the patient cannot be billed for the service.

NGS encourages providers’ billing and credentialing departments to keep open communication.

Keep in mind, submitting claims prematurely causes:

• Additional administrative costs
• Increased workloads
• Decreased efficiencies

For more information on enrolling a rendering provider, see How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B.

Posted 4/2/2021