Frequently Asked Questions

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FAQ

By Topic: Provider Enrollment & Certification


What is an IRS Form CP 575?
The IRS Form CP 575 is an Internal Revenue Service generated letter you receive from the IRS granting your Employer Iden... (more)

How do I know if I have a PECOS Record?
There are three (3) ways to verify that you have an enrollment record in PECOS: Check the O... (more)

How do physicians join or leave a group?
If both the physician and the group are already enrolled with the same carrier, the physician and the group together are... (more)

How do you make changes to the provider enrollment information on file with your fee-for-service contractor?
Providers and suppliers should report changes using the applicable provider enrollment application (CMS-855) for your pr... (more)

Is there a way for providers to check the status of an enrollment application they have submitted for order...
Yes. If you submitted an enrollment application for ordering/referring purposes on paper or via Internet-based PECOS and... (more)

How much is the application fee?
The application fee is currently $532 for CY2013; however, based upon requirements set forth in Section 6401(a) of the A... (more)

Who do I contact if I have questions about supporting documents required to be submitted with my revalidati...
Questions related to supporting documents, application fees and the status of your revalidation application should be di... (more)

Why do I have to pay a Medicare enrollment application fee?
Section 6401(a) of the Affordable Care Act (ACA) requires the Secretary to impose a fee on each "institutional provid... (more)

If I am joining a Group, will I need to submit the Group’s National Provider Identifier (NPI) in section 4B...
In Section 4B of the CMS-855I, the NPI of the Group should be entered if it has been issued to the Group. If you are jo... (more)

I recently hired a new office manager. In addition, we will be moving next week. Should I submit that infor...
Providers/suppliers should continue to submit routine changes in a timely manner. If the provider/supplier also receives... (more)

How often will  providers and suppliers be required to revalidate?
Providers/suppliers are required to revalidate every 5 years on the anniversary of their approved PECOS enrollment. ... (more)

Can I fax a copy of the provider enrollment application to the Medicare contractor?
No. Since the enrollment application must contain an original signature, you cannot fax an enrollment application to a ... (more)

Do I have to submit an Electronic Funds Transfer Authorization Agreement (EFT) (Form CMS- 588) with the rev...
All providers/suppliers are required to submit a new Form CMS-588 with their revalidation application.  Excluded... (more)

How can I submit my revalidation?
There are two options to submit your revalidation application: 1) Internet-based PECOS located at ... (more)

Can you please provide the reference link that identifies those providers and suppliers who will be deemed ...
The following links you directly to the article which addresses the ACA related enrollment changes: ... (more)

What address will my revalidation letter be sent to?
The revalidation letter will be sent to the special payments and correspondence addresses simultaneously. If these are t... (more)

How do I pay my application fee when submitting a Medicare enrollment application, and what happens after I...
Application fees will continue to be made electronically through Pay.gov. However we are changing the access to Pay.gov ... (more)

When using Internet-based PECOS, am I still required to print, sign and mail my certification statement to ...
Internet-based PECOS now allows providers to sign Medicare enrollment applications electronically.  &nb... (more)

My initial Medicare enrollment was approved Do I have to revalidate?
Excluded from the revalidation requirement are providers/suppliers that were initially enrolled or voluntarily revalidat... (more)

The authorized and delegated officials and the owners of our medical group changed last year. Who should si...
All changes in ownership and authorized/delegated officials must be reported when submitting your revalidation applicati... (more)

What is revalidation and why must I revalidate?
In accordance with the Patient Protection and Affordable Care Act, Section 6401, all new and existing providers must be ... (more)

With respect to the site visit, how can we determine which screening category we are in ? How do we know if...
Beginning on March 25, 2011, Medicare will place newly-enrolling and existing providers and suppliers in one of three... (more)

If I inappropriately/erroneously obtained an NPI and later found that I am not eligible for an NPI, how can...
If an NPI were obtained and the applicant found that he/she/it should not have obtained one, the NPI holder should send ... (more)

Are veterinarians eligible to obtain NPIs?
Veterinarians are not eligible for NPIs because they do not meet the regulatory definition of “health care provider” ... (more)

What are the provider enrollment screening levels?  
Section 1866 (j)(2) of the Act requires the Secretary to determine the level of provider enrollment screening applicable... (more)

I am the sole owner of multiple practice locations.  Do I need to submit a CMS-855I for each location?
Each unique Tax Identification Number (TIN) requires a separate CMS 855 form.  If multiple practice locations conta... (more)

What Are the Requirements for Ordering/Referring?
There are three basic requirements for ordering/referring:   • The physician or non-physician pr... (more)

Will there be a way to revalidate without having to complete the entire enrollment application again?
Yes, Using Internet-based PECOS to revalidate allows you to review information currently on file, update and submit your... (more)

If an individual is an intern, resident, or fellow, does he or she have to be licensed in order to register...
No.  The Interim Final Rule with Comment (IFC) mandated that all interns and residents who order and refer specify ... (more)

I bill Medicare for items and services that were ordered or referred. How can I be sure that my claims for ...
You need to ensure that the providers from whom you accept orders and referra... (more)

How long does it take to process my revalidation application?
If the application is submitted complete and with all required supporting documentation, it should be processed in less ... (more)

Is there a way for providers to verify their enrollment in Medicare for ordering/referring purposes?
Yes.  On the CMS Medicare provider/supplier enrollment website there is an Ordering Referring Report that conta... (more)

I have not received a revalidation letter yet from my Medicare Contractor. Should I submit a revalidation e...
Your Medicare Contractor will be sending out revalidation letters over an extended period of time. Please DO NOT subm... (more)

If I find a Healthcare Provider Taxonomy Code applicable to my specialty or applicable to the type(s) of se...
No.  In order to be eligible for an NPI, the applicant must meet the definition of a “health care provider” as d... (more)

How do I submit a fee for multiple enrollments under the same Tax ID?
You must separately submit the required application fee payment for each enrollment application under the same Tax ID. ... (more)

Which MLN Matter Article talks about the provider enrollment changes?
The following links you directly to the article which addresses the Affordable Care Act related enrollment changes: ... (more)

Who can I contact if I have problems submitting my application fee?
If you are having a problem completing your application fee payment,1) Please contact the EUS help desk at 1-866... (more)

I am an Opt-out physician. Will I need to revalidate to keep my opt out status?
Physicians and non-physician Practitioners who have opted-out of the Medicare program are not required to revalidate.&nb... (more)

The revalidation letter received includes Provider Transaction Access Numbers (PTANs) that are not used any...
This letter includes all of the provider’s active PTANs as listed in PECOS.  It is the provider’s responsibility to... (more)

If the information in my revalidation is different than what you have on file about my practice location, a...
The purpose of this revalidation is to ensure all provider enrollment records are accurate and up to date. Generally, CM... (more)

Where can I find additional information on the revalidation process?
The following information is available at ... (more)

Am I required to submit an application fee with my revalidation application?
With the exception of physicians, non-physicians practitioners, physician group practices and non-group practices, pr... (more)

If an individual is employed by an agency that is not eligible for Medicare billing or is an intern or resi...
Yes.  With the implementation of Section 6405 of the Affordable Care Act, CMS permits certain physicians or othe... (more)

Will I be contacted if my application is found to be incomplete or missing information?
Yes, you will receive a letter requesting the missing information via mail, fax or email.  All information is du... (more)

What is the difference between using the Internet-based PECOS and a paper form to submit my revalidation?
Internet-based PECOS allows you to review information currently on file, update and submit your revalidation via the Int... (more)

Will there be a gap in payment while my application is being processed?
There will be no gap in payment once your complete revalidation application is received by the Medicare contractors.... (more)

What do I need to do in order to become reactivated?
In order to be considered for reactivation you need to submit a revalidation application by using the Internet-based PEC... (more)

I am a provider practicing in several contractor jurisdictions. Can I submit one provider enrollment revali...
You will receive a separate request to revalidate from each of the Medicare Administrative Contractors (MACs) and you... (more)

If a supplier makes solicited contact with a beneficiary for a particular covered item, can the supplier sp...
No. If this is the first contact ever made by the supplier to the beneficiary, then the supplier is prohibited from atte... (more)

Am I still required to submit a voided check or letter from the bank with my CMS 588 EFT form?  If so,...
Providers/suppliers are still required to provide confirmation of account information via bank letterhead or voided chec... (more)

We are a Hospital Based Multi-Specialty physician group practice, an Office Based Multi-Specialty physician...
Physician and non-physician group practices are not required to pay the application fee at the time of initial enrollmen... (more)

What will occur if I do not respond to the revalidation request within a timely manner?
Failure to respond to a revalidation notice could result in the deactivation of your Medicare billing privileges. ... (more)

The PTAN submitted on the revalidation letter is only my group’s PTAN.  Do I need to revalidate all of...
No.  If the revalidation letter is for the group, then the revalidation is for the entity only.  If the indivi... (more)

What must a DMEPOS supplier furnish to CMS during the enrollment process to be in compliance with the licen...
... (more)

What is the final rule for ordering and referring and its implications?
CMS published the [CMS-6010-F] RIN 0938-AQ01 Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollm... (more)

Why do we have to revalidate when we have been billing and getting paid?
Various sections of the Social Security Act and the Code of Federal Regulations require providers and suppliers to furni... (more)

Can I mail in my application fee payment or pay over the phone?
No. CMS cannot accept payments by mail or phone.... (more)

What if I forgot my PECOS User ID or Password?
If you cannot remember your User ID, you may select the “Forgot User ID?” link on the PECOS home page.  Forgotten p... (more)

For those providers and suppliers subject to site visits, who will conduct the site visits?
Announced and unannounced site visits are required prior to enrollment for initial enrollment, new practice locations... (more)

Can I submit a photocopy of the provider enrollment application?
Yes. While it is acceptable to photocopy the enrollment application, it is unlawful to alter it in any manner. Moreover,... (more)

How will the technical vs. professional components of imaging services be affected by the edits when implem...
Consistent with the Affordable Care Act and 42 CFR  § 424.507, suppliers submitting claims for imaging services mus... (more)

Will I be notified once my revalidation enrollment is processed?
Yes, your Medicare Contractor will send an approval letter when your revalidation application has been processed.  ... (more)

I forgot my PECOS password, is there a link to reset my password?
To reset your PECOS password click the Forgot Password link on the PECOS homepage found at ... (more)

I plan on retiring shortly, do I still have to revalidate?
If you are asked to revalidate, please respond to the revalidate request. If you have already retired and are no longer ... (more)

How do I apply to order or refer if I am a physician who is of a type/specialty that is eligible to order a...
Physicians or other eligible professionals can apply for enrollment for the sole purpose of ordering and referring items... (more)

How and when will these edits be implemented?
Effective January 6, 2014, CMS will instruct contractors to turn on Phase 2 denial edits on the following claims to c... (more)

I have an established record in the Provider Enrollment Chain and Ownership System (PECOS).  How do I ...
Once you have logged into PECOS, select “My Enrollments” from the Welcome Page and then “View Enrollments”.  Identi... (more)

I submitted my revalidation application after receiving a deactivation letter; however, I still appear in a...
The Medicare Contractor should remove the deactivation upon receipt of your revalidation application.   If thi... (more)

What is Pay.gov?
Pay.gov is operated by the U.S. Department of the Treasury and is a web-based application that allows you to make online... (more)

Is a revalidation required if recent changes have been made and submitted by using 855 forms?
Even if a provider recently submitted changes to their enrollment application, the provider or supplier must still respo... (more)

I have received a deactivation letter stating my Medicare billing privileges have been deactivated. What do...
Failure to respond to a revalidation notice shall result in the deactivation of the provider/supplier's billing privileg... (more)

When State licensure is required to furnish a DMEPOS item or service, what is the required employment relat...
In these situations, the lic... (more)

My entity is enrolling/revalidating its enrollment as a federally-qualified health center (FQHC). Is it sub...
Yes, a newly enrolling or revalidating FQHC is subject to the application fee. However, if your entity believes the appl... (more)

How long do I have to submit the revalidation application?
Upon receiving the Medicare Contractor request to revalidate your enrollment, you will have 60 days from the date of ... (more)

If a billing provider submits a claim for referred clinical laboratory and imaging services from a provider...
Yes.  The claim will deny because the referring provider who is located outside of the US is ineligible to enrol... (more)

Who May Order/Refer for Medicare Part B and DMEPOS Beneficiary Services?
Only Medicare-enrolled individual physicians and non-physician practitioners of a certain specialty type may order/re... (more)

Does the application enrollment fee apply to those who submit the 855 S?
Yes.... (more)

What are the ordering and referring edits?
The edits will determine if the Ordering/Referring Provider (when required to be identified in Part B, DME, and Part A H... (more)

Will I continue to receive Medicare payments while my MAC is processing my revalidation?
Yes.... (more)

An Ophthalmologist performs cataract surgery and refers the patient to an Optometrist for post cataract car...
The provider that prescribed the glasses should be listed on the claim.  If the Ophthalmologist and the Optomet... (more)

What Part B claims are impacted by the ordering/referring denial edits?
Only part B claims submitted for clinical laboratory and imaging services will be impacted by the edits.  Imaging s... (more)

I'm not comfortable with making payments online. Can I mail in my payment or pay over the phone?
No. Do not mail application fee payments. Payments cannot be accepted by mail or phone. Please note that all fees must b... (more)

Is the beneficiary liable for payment if the claim is denied for failing the ordering/referring edits?
Claims from billing providers and suppliers that are denied because they failed the ordering/referring edit shall not ex... (more)

Will there be a penalty for not reporting the ownership change?
Medicare requires that providers and suppliers inform Medicare of changes in any enrollment information. In accordance w... (more)

Am I required to receive Medicare reimbursement electronically through electronic funds transfer?
Section 1104 of the Affordable Care Act (ACA) further expands Section 1862 (a) of the Social Security Act mandating fede... (more)

How will the remaining claims be handled, if a Medicare beneficiary was ordered a 13-month DME capped renta...
Claims for capped rental items will continue to be paid for up to 13 months from the physician’s date of deactivate to a... (more)

I need more time to complete my revalidation application.  How can I request an extension?
Extension requests should be coordinated with your Medicare Contractor and requested in writing (fax/email permissibl... (more)

My initial Medicare enrollment was approved recently. Do I have to revalidate?
Excluded from the revalidation requirement are providers/suppliers that were initially enrolled or voluntarily revalidat... (more)

I order and refer.  How will I know if I need to take any sort of action with respect to the ordering ...
In order for the claim from the billing provider (the provider who furnished the item or service) to be paid by Medicare... (more)

Is a supplier contacting the beneficiary based on the receipt of a physician order considered an "unsolicit...
If a physician contacts a supplier on behalf of a beneficiary with the beneficiary's knowledge, and then a supplier cont... (more)

How will hospital based imaging services be affected by the edits?
Hospital based imaging services billed with place of service (POS) codes 21 (Inpatient Hospital), 22 (Outpatient Hospita... (more)

How do I change or cancel an application fee payment?
If you have a payment you need to change or cancel, please contact CMS’ External User Services Help Desk at 1-866-484-80... (more)

Who May Order and Refer for Medicare Part A Home Health Agency (HHA) Beneficiary Services?
Only Medicare-enrolled individual physicians of a certain specialty type may order/refer for Part A when a plan of tr... (more)

We are a pharmacy. What is the deadline for us to submit our revalidation?
The MAC, including the National Supplier Clearinghouse (NSC) will notify each supplier to revalidate. Suppliers and prov... (more)

Will large groups consisting of 200+ reassignments be notified when the providers within their group have b...
Yes.  Within 15 days of receiving the CMS list of providers required to revalidate, Medicare Contractors will ma... (more)

I am the enrollment contact for a large group with 200 or more reassignments and have received the group no...
At this time, CMS is not permitting groups to revalidate multiple providers at once using the spreadsheet provided as pa... (more)

When submitting application fees for multiple enrollments under the same Tax ID, how will CMS know which PT...
If you are submitting more than one payment, CMS uses the Tax ID to match the payment to your application. It does not m... (more)

Do the ordering/referring edits apply to Hospitalist who are licensed physicians employed by a hospital?
Doctors of medicine or osteopathy, and doctors of podiatric medicine are the only Medicare-enrolled individual physician... (more)

What information must be included in the documentation maintained by the enrolled supplier that is responsi...
The medical records maintained by the DMEPOS supplier must include the DMEPOS supplier’s name, the licensed individual’s... (more)

Will the Phase 2 edits be effective based on the date of service or the date of claim receipt?
The edits are effective for claims with dates of service on or after the implementation of the Phase 2 denial edits.&nbs... (more)

For home health care claims what date is used to determine if the claim will be paid when the denial edits ...
The “From Date” on the claim will be used to determine if the claim is paid.  Claims submitted with a “From Date” o... (more)

What is an "ACH" payment?
ACH stands for "Automated Clearing House" and refers to an electronic debit from a checking or savings account, commonly... (more)

What is the payment processing schedule for Pay.gov?
The Pay.gov site is available 24 hours a day, 7 days a week (holidays included) for users to submit payments, with th... (more)

Will previously denied claims, in cases where a claim is submitted after January 6, 2014, be paid on resubm...
If the ordering physician’s date of enrollment is prior to the date of service on the claim, upon resubmission, the clai... (more)

Is the fingerprinting for the High Risk providers a part of the revalidation effort?
As of December 31, 2011, fingerprinting is not part of revalidation.... (more)

Is global billing still allowed after January 1, 2012 when the accreditation requirement goes into effect?
Yes, global billing is still allowed; however, if you are not accredited and you submit a global claim for an ADI servic... (more)

I am the enrollment contact for a group with less than 200 reassignments.  Will I receive a group noti...
No.  Groups with less than 200 reassignments will not receive a letter or spreadsheet from their Medicare Contracto... (more)

Who should be listed as the ordering/referring physician on the claim when an Ophthalmologist performs cata...
The provider that prescribed the glasses should be listed on the claim. If the Ophthalmologist and the Optometrist are o... (more)

Under what circumstances can a DME supplier make telephone contact with a beneficiary regarding a Medicare ...
If the beneficiary gave written permission for the supplier to contact him/her, or If ... (more)

Will the Phase 2 edits deny claims ordered by providers whose applications are “pending” with the Medicare ...
CMS will deny claims for ordering/referring providers whose applications are currently in a “pending” status. The physic... (more)

What types of claims are impacted by the Ordering and Referring edits?
The ordering/ referring provisions of the final rule only apply to items of DMEPOS, imaging and clinical laboratory serv... (more)

Does 6028-FC require Part A/Part B health care providers that employ physicians and nonphysician practition...
6028-FC does not require providers to query a database. Pursuant to our recently published rule newly-enrolling and e... (more)

Does the provider have any say in determining in which screening category they are placed?
The following link takes you directly to the MLN article which addresses the ACA related enrollment changes: ... (more)

What if my claim is denied inappropriately?
If your claim did not initially pass the Ordering/Referring provider edits, you may file an appeal through the standard ... (more)

When would a provider/supplier be permitted to cancel EFT?
Cancelling EFT enrollment is a choice not applicable to most situations and will rarely be used.  Cancelling EFT en... (more)

What are the accepted credit card types for the application fee?
Pay.gov accepts Visa, MasterCard, American Express, and Discover.  ATM-only cards and debit cards from other proces... (more)

Why am I getting informational messages for the professional component of imaging services?
Billing providers may currently be receiving informational messages when billing for the professional component.&nbs... (more)

Does a supplier have to collect and maintain documentation from the physician reflecting that the physician...
No. However, it would be a business decision on the part of the supplier whether to collect and obtain such documentatio... (more)

Why do I currently receive informational messages when I submit a claim for Ordering/Referring?
Laboratories, imaging centers, DMEPOS suppliers, and HHAs receive this message if the ordering/referring provider report... (more)

How do I know my application fee payment was successful?
At the end of submitting your payment, you will see a confirmation screen indicating your payment was successful. This c... (more)

I have not received a revalidation letter yet from my Medicare Contractor. Does that mean I do not have to ...
No, that does not mean you do not have to revalidate. Your Medicare Contractor will be sending out revalidation letters ... (more)

Is there any requirement for MACs to verify this address with the address on file or the address provided o...
Provider Enrollment MACs should verify the EFT form is complete and request an update if it is not complete.  Provi... (more)

Why is Medicare implementing these edits?
These edits help protect Medicare beneficiaries and the integrity of the Medicare program. ... (more)

How will the application fee transaction appear on my bank or credit card statement?
Pay.gov transactions will usually appear with the description "CMS Medicare applic fee." If you're not sure what a parti... (more)

Will my revalidation notice come in a specific color envelope from the Medicare Contractor?
CMS encourages all Medicare Contractors to use a yellow colored envelope.  However, it is not required that a yello... (more)

Can MACs develop for the correct version of the CMS 588 (Electronic Funds Transfer (EFT) Authorization Agre...
CMS would prefer the MACs develop for the correct version of the EFT form.  MACs should not return the entire enrol... (more)

Will my revalidation notice come in a specific color envelope from the Medicare Contractor?
CMS encourages all Medicare Contractors to use a yellow colored envelope.  However, it is not required that a yello... (more)

Is a supplier returning a beneficiary's phone call considered an "unsolicited" contact?
No. In that scenario, the beneficiary initiated the contact and is inviting a response from the supplier.... (more)

Is Pay.gov secure?
Yes. Pay.gov uses 128-bit SSL encryption to protect your transaction information while you're logged in to Pay.gov. In a... (more)

How quickly is my credit card payment for the application fee processed?
Credit card payments submitted by midnight Eastern Standard Time will settle in your account the next business day.... (more)

What do I do if I’m sure I didn’t authorize an electronic transaction?
First, review your records to make sure there are no missing transactions that haven’t been recorded.  The next ste... (more)

We are a pharmacy. When should we pay the fee for revalidation?
The fee must be paid before the revalidation application can be processed unless the institutional provider or supplier ... (more)

We are a pharmacy. Will we get separate revalidation requests for each entity?
In most instances each enrolled provider will receive a separate request to revalidate. Each enrolled institutional prov... (more)

Are breast pumps and/or breast pump supplies covered under the Medicare durable medical equipment standards?
Breast pumps and breast pump supplies are not covered by Medicare in any circumstance.... (more)

What is the fingerprint requirement?
... (more)

How is the “high” level of risk determined?
... (more)

Why is the Centers for Medicare and Medicaid Services (CMS) requiring individuals to be fingerprinted?
... (more)

How much time will I have to be fingerprinted?
... (more)

How will I know where to go to be fingerprinted? 
... (more)

What types of locations will be provided? 
... (more)

Is there a cost to be fingerprinted?
... (more)

What happens if all of the 5% or greater owners of my organization do not get fingerprinted within 30 days ...
... (more)

Will I receive notification when my background check is completed?
... (more)

Does the Fingerprint Based Background Check (FBBC) contractor have an Originating Agency Identifier (ORI) n...
... (more)

Who is required to be fingerprinted?
... (more)

How will I know if I should be fingerprinted?
... (more)

What if I receive a letter which lists individuals no longer with my organization?
... (more)

What if I receive a letter that does not list all 5% or greater owners for my organization?
... (more)

Once I am fingerprinted, what happens next?
... (more)

Is the Fingerprint Based Background Check (FBBC) contractor certified under the Federal Information System ...
... (more)

If I am a part of multiple Medicare enrollments, will I be required to be fingerprinted more than once?
... (more)

What if I have been fingerprinted previously for reasons other than my Medicare enrollment?
... (more)

How can the fingerprint contractor be contacted?
... (more)

Who is responsible for the cost of the fingerprinting?
... (more)