About Medicare Provider Enrollment

Process of Submission and Timeframes

The CMS-855A application is processed by the audit Contractor.  For initial enrollments and additional location requests, some states require the issuance of a Certificate of Need (CON) or state license prior to starting up the agency.  Before completing and submitting the CMS-855A application, please contact the State agency where your facility is physically located to determine the appropriate state participation and certification requirements, and to obtain any State required forms that must be completed.

The Contractor completes an initial review, or prescreen, of the CMS-855A application within 15 calendar days of receipt.  If the application doesn’t meet the general requirements for acceptability (e.g., not signed or signature not original, full 855A not submitted as required, etc.) the application is returned prior to a review.  If the general acceptability requirements are met, the prescreen review is conducted.  If during the prescreen, all required sections of the application are not completed properly and/or required attachments are missing, the applicant is notified in writing of the specific requirements that need to be addressed.  Once the requirements are met, a verification of the data elements is performed and the enrollment information is input into the CMS database, the Provider Enrollment Chain and Ownership System (PECOS).  If additional or clarifying information is needed during the verification process (e.g., SSN or NPI doesn’t verify in PECOS), the applicant will be contacted. 

It is the applicant’s responsibility to review and respond to the information request.  This request is the only notification the provider will receive.  If the applicant does not respond to the information request or only submits partial information, the application will be rejected.  If rejected, and the provider decides to resubmit, a complete new application and supporting documentation will need to be sent.  The process will then start over.  Please note that when Cahaba needs to request additional information and/or reject the application, this delays the enrollment process.  It is the provider’s responsibility to ensure a complete and accurate CMS-855A is initially submitted, with all required attachments included.  The documentation from the National Plan and Provider Enumeration System (NPPES) that shows the provider’s National Provider Identifier (NPI) is no longer required to be sent in with the CMS-855A, but may be requested during our review if there are issues verifying the NPI to the Tax ID and legal business name.  The CMS-588, Authorization Agreement for Electronic Funds Transfer (EFT), is also required to be sent in with the CMS-855A, for providers that are not current on EFT, or those that are requesting a change.  The timeframe for processing the CMS-855A for initial enrollments (, new owner changes of ownership, consolidations, and acquisitions/mergers, and full applications (complete applications are required for providers that have not submitted an application since the implementation of the Provider Enrollment Chain and Ownership System on July 29, 2002, for voluntary submissions, revalidations, and for reactivations) is 60 calendar days from receipt of the application.  The timeframe for processing all other types of CMS-855A requests is 45 calendar days from receipt of the application.  In the event of extenuating circumstances, the timeframes may be delayed.  In order to expedite the review, the applicant should be available to assist with questions and respond to requests for additional or clarifying information within the requested timeframes.

Once the Contractor review is complete, a recommendation for approval or denial is made to the CMS Regional Office (RO) and the State Agency where the applicant is located.  For initial enrollments and other action types that require a state survey to ensure Medicare conditions of participation are met, the state agency will establish a timeframe to conduct this.  Once complete, the State will notify CMS of the recommendation.  The CMS RO will issue the final determination via a CMS-2007, certification notice (aka Tie-In Notice) and provider agreement.  For initial enrollments and changes of ownership, the process could take six to nine months or longer.  There are no specific time requirements for the State Agency and CMS RO review period.  Once the contractor recommendation is issued, the applicant should contact the State agency or CMS RO if there are any questions regarding the status of the process.  The applicant should be aware that for changes of ownership, acquisitions/mergers, and consolidations, that Medicare payments will continue to be made to the old owner(s) until the transaction is approved by the CMS RO, even if the old owner submits a CMS-588, Agreement for Electronic Funds Transfer, to change the bank account to that of the new owner.

After the Contractor receives the certification notice, the necessary enrollment information is input into the contractor systems.  This process could take up to ten days to be complete.  After all system updates have been made, the provider may bill for services.

Provider Enrollment Educational Resources

• Information and Education Resources for Medicare Providers, Suppliers, and Physicians
• Medicare Enrollment for Institutional Providers
• Medicare Program Integrity Manual, CMS Publication 100-08, Chapter 10, Healthcare Provider/Supplier Enrollment
• Centers for Medicare and Medicaid Services (CMS) Enrollment Web site 
• State Operations Manual
• Medicare fraud and abuse prevention
• Medicare Learning Network (MLN) Articles:
  • Provider Enrollment in the Medicare Program
  • Announcing the Release of the Revised CMS-855 Medicare Enrollment Applications

Additional Section Links

• Provider Enrollment Introduction
• About Medicare Provider Enrollment
• Provider Enrollment Packet
• Provider Enrollment Frequently Asked Questions
• Electronic Funds Transfer (EFT)

Page last updated: May 7, 2008

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