Looking for a public enrollment record? Search CMS Medicare enrollment data by NPI and check the source period. A dataset match does not confirm current billing privileges.
We specialize in all aspects of Medicare Enrollment and will work quickly and correctly to complete the enrollment process with your local Medicare administrator. We offer our Medicare credentialing services nationwide and have completed over 15,000 Medicare applications over the past 18 years. We can also provide assistance if your Medicare application has been delayed or returned due to errors on your end or on the part of the enrollment analyst at Medicare. Medicare issues can cost you thousands of dollars in lost revenue if done incorrectly.
- Nationwide Medicare Experts
- Certified Coders and Credentialing Professionals
- Successfully enrolled over 15,000 providers since 2008
- Familiar with all aspects of Medicare Enrollment process
- Credentialing specialists familiar with Medicare Administrative Contractors (MACs)
- 100% of Staff is based here in the US
Medicare Credentialing Scenarios
Medicare enrollment does not automatically transfer when you move to another state, join a different practice or add a location. The required application or enrollment update depends on the change. Confirm what Medicare requires and the applicable billing effective date before submitting claims for the new arrangement.
Here are some common scenarios where a Medicare enrollment specialist is helpful:
- Did you open a new practice location? Have you notified Medicare so you can bill for the services?
- Did a physician leave your practice in the past? Are you aware that Medicare must be notified of this change?
- Have you changed billing companies? This new agency must be on file with Medicare.
- Did you have a change of ownership? This must also be provided to Medicare.
- Are your claims being denied and you are not sure why?
- Are you opening an office and not sure where to start?
- Would you like to bill for DME but don’t have a supplier number?
Medicare Application Types
- Institutional/Facilities: CMS-855A
- Clinics/group practices and certain other suppliers: CMS-855B
- Physicians and non-physician practitioners (including clinical psychologists, nurse practitioners, therapists, physician assistants and most other provider types): CMS-855I
- Reassignment of benefits, including linking a provider to a Medicare group: CMS-855I. Reassignment reporting is now included in CMS-855I; CMS-855R has been discontinued.
- Ordering, certifying and prescribing providers: CMS-855O
- Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers: CMS-855S
- PECOS
- We have a very helpful tutorial on using PECOS which can be found here.
Retroactive Billing for Medicare
The short answer is Yes, but there are some specifics that you need to be aware of. Retroactively billing Medicare is critical for most organizations as providers often start without having a Medicare number. Your retroactive period begins once an application has been submitted but the application submitted must be accepted.
If the application is rejected due to incomplete data or because a provider doesn’t meet Medicare standards, you will lose the retroactive billing date and must start the application process over. This is why it’s so critical to stay on top of the Medicare enrollment process and ensure your application is processed without any issues. If mailing anything to Medicare, be sure to send certified and keep a copy of the tracking certificate. If submitting through PECOS, make sure to get a tracking id and regularly check on the status.
Read more: Retroactive Medicare billing and enrollment effective dates.
Medicare Revalidation
Check Medicare revalidation by NPI to see listed due dates and source dates before you begin. No login required. Confirm current requirements with CMS or your Medicare Administrative Contractor.
How often do you need to revalidate Medicare?
Medicare providers and suppliers generally revalidate their enrollment every five years; DMEPOS suppliers generally revalidate every three years. CMS can also request an off-cycle revalidation. See CMS revalidation guidance for current requirements.
How do I revalidate Medicare?
You can revalidate through PECOS or use the applicable paper application. PECOS lets you review your existing record, upload supporting documents and sign electronically. PPS can help prepare and submit your revalidation; that assistance uses the same Medicare enrollment channels.
What are the risks if I fail to revalidate?
Missing a required revalidation can lead to deactivation of Medicare billing privileges and a gap in payment. Follow your contractor’s notice and respond by the applicable deadline.
Is my enrollment record due for revalidation?
Check the CMS Medicare Revalidation List and any notice from your contractor for your due date. Follow current CMS instructions rather than relying on a previous deadline or an old grace period.
Completing a PECOS Application
We recommend PECOS for applications supported by the system. It provides an online way to prepare, submit and track Medicare enrollment applications. Processing times vary, so monitor your submission and respond promptly to requests from your Medicare Administrative Contractor.
PECOS includes checks that help identify missing information. Review the provider, organization, NPI and location details carefully before submission; automated checks do not replace a complete application review.
For more information on PECOS or to complete a Medicare application using their system, visit their website at: https://pecos.cms.hhs.gov/pecos/login.do
We have provided a very helpful article on completing your PECOS Medicare application here.
Medicare Enrollment Services We Provide
- PECOS profile setup and application submission. You can view your PECOS profile here: https://pecos.cms.hhs.gov/pecos/login.do
- Enrollment for your new entity, any locations and all providers within your organization
- Complete the enrollment process for your new entity and ensure your individual Medicare number is properly linked.
- Complete all necessary applications and forms depending on the type of facility or situation.
- Obtain your Group NPI if necessary and ensure the crosswalk between Medicare and NPPES is set up correctly.
- Complete the Electronic Funds Transfer and Electronic Data Interchange process (EFT & EDI)
- We do it all and let you focus on the 900 other things that you need to do.
Medicare Articles
Provider Types We Work With
We support these provider types:
- Physicians
- Hospitals
- Imaging Facilities
- DMEPOS Groups
- Nurse Practitioners & Physician Assistants
- Behavioral Health Specialists
- Licensed Clinical Social Workers
- Chiropractors
- Other eligible Medicare providers and suppliers
Provider Enrollment
Our Medicare provider enrollment services are offered nationwide to individuals and groups.
DME Enrollment
We handle initial and revalidation applications for new and established DMEPOS suppliers.
Facility Enrollment
We provide initial and revalidation Medicare enrollment services to hospitals of all types and sizes.
Lab Enrollment
Medicare enrollment and facility credentialing offered to labs in all 50 states.
CMS Fee Schedule Tool
Do you know what each office visit or procedure is paying you?
How much more does a 99203 pay than a 99213?
This valuable fee schedule tool provided by CMS will tell you how much each code is paying currently and how much they have paid historically. Many of your insurance contracts are based on prior year Medicare fee schedules so it is vital that you are equipped with this knowledge. In this tutorial, we show you exactly how to utilize this tool to analyze your top codes.