Provider Based Determinations

Table of Contents Provider Based Determinations Processing of Provider-Based Determinations MAC Provider-Based Designation Checklist Related Content [Return to Top] Provider Based Determinations On 4/18/2003, CMS issued a Program [...]

FY 2025 Occ Mix Hospital Letter Final

FY 2025 Occ Mix Hospital Letter Final CY 2022 Medicare Occupational Mix Survey Submission Section 1886(d) (3) (E) of the Social Security Act requires CMS to collect data every three years on the occupational mix of employees for each [...]

Contacting Medicare

Contacting Medicare Medicare constituents (or People with Medicare) can have their Medicare questions answered by calling 1-800-MEDICARE (1-800-633-4227) 24-hours a day; 7-days a week. 1-800-MEDICARE users can speak to a live person either by [...]

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 [...]

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 [...]

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 [...]

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 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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

Ordering and Referring Provider

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

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 [...]

Who Needs to Pay Application Fees

Who Needs to Pay Application Fees Institutional providers and certain suppliers must pay an application fee or submit a hardship exception when initially enrolling, revalidating their enrollment or adding a new Medicare practice location. [...]

Description of Application Fee

Description of Application Fee The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2024 is $709. Related Content Federal Register Notice ‒ information [...]

How to Pay the Application Fee

How to Pay the Application Fee The application fee must be paid electronically. IMPORTANT: If submitting a hardship request, it must be submitted with the enrollment application. It cannot be accepted separately. To pay the application fee [...]

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 [...]

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 [...]

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 [...]

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: [...]

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 Common Errors and [...]

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 [...]

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 [...]

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 [...]

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 [...]

OTP

This section gives you access/education about first time Enrollment.

CERT Text Durable Medical Equipment

Need to Appeal a CERT Denial? Log onto our secure NGSConnex online Web application and quickly file an appeal. Submitting an appeal electronically saves postage, print and mail costs and is easy to do through NGSConnex.com. If you do not [...]

Unsubscribe Step 3 Description

Step 3: Unsubscribe To unsubscribe completely from all e-mail updates, please select the Unsubscribe button below. You will be removed from all of our e-mail lists immediately.

crosswalkUsage

CEDI NPI Crosswalk Tool:  A crosswalk is the link established between the National Provider Identifier (NPI) and durable medical equipment (DME) Provider Transaction Access Number (PTAN) (supplier ID). Verify your link using the tool [...]

Manage Account Enter E-mail Step 1 Description

Manage Account To get started, please validate your e-mail address account information. Step 1:  Please enter your e-mail address and password:

Overpayment Results-Home Health and Hospice

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Thank you for using the National Government Services Immediate Recoupment Request Form - Electronic/E-mail. Your request has been received and will be processed within [...]

Unsubscribe Confirmation Page Content

Unsubscribe Thank you for your recent submission. What you can expect: A confirmation e-mail will be sent to the e-mail address under which you registered your account.

Travel Allowance Resources

Note: Codes that have a $0 (zero) fee schedule amount will not display a search result. Locality/Area and County Information for New York Locality/Area Counties 01 Manhattan 02 [...]

PsychCal_top

PSYCHIATRIC SERVICES CALCULATOR Due to the complex nature of the psychiatric service reduction, use this calculator in your day-to-day business operations to help determine the correct financial liability for both Medicare [...]

Molecular Pathology Resources

Note: Codes that have a $0 (zero) fee schedule amount will not display a search result. Locality/Area and County Information for Illinois Locality/Area Counties 12 Bond, [...]

DMEFee Form Description

Note: This tool only provides pricing modifiers for the HCPCS entered in your search. Please refer to the medical policies for any additional modifier information for claims submission.

Overpayment E-mail-Part B

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Please do not reply to this message. This e-mail address is automated, unattended, and cannot help with questions or requests. Thank you for using the National [...]

Influenza Form Description

Overpayment E-mail-Part A

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Please do not reply to this message. This e-mail address is automated, unattended, and cannot help with questions or requests. Thank you for using the National [...]

Create Profile Enter Email Step Description

E-mail Account Validation To get started, please validate your e-mail address account information. Step 1:  Please enter your e-mail address:

Travel Form Description

Learn About Deactivation of Billing Privileges, Suspension of Payment and Reactivation

This site area gives you access to important information about deactivation of billing privileges, suspension of payment and reactivation.

PC-ACE Pro Patch for NHIC Text

PC-ACE Pro 2.31 Patch For NHIC

DMEPOS Resources

Note: Codes that have a $0 (zero) fee schedule amount will not display a search result. Locality/Area and County Information for Illinois Locality/Area Counties 12 Bond, Calhoun, Clinton, Jersey, [...]

E-mail Sent Password Reminder Page Content

E-mail Sent An e-mail has been sent with your password.

Overpayment E-mail-Federally Qualified Health Center

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Please do not reply to this message. This e-mail address is automated, unattended, and cannot help with questions or requests. Thank you for using the National [...]

Manage Account Step 2 Description

Manage Account Step 2:  Manage account preferences -or- proceed to Step 3 if you would like to unsubscribe from receiving e-mail updates: