Complete Medicare enrollment and maintenance
Medicare enrollment is one of the most consequential and complex credentialing processes a provider faces. Getting it wrong can delay billing privileges by months. Getting it right requires knowing CMS rules, MAC preferences, and the specific documentation CMS reviewers expect to see.
Medicare Part B Enrollment via PECOS
Complete PECOS enrollment for individual physicians, non-physician practitioners, and group practices. We handle account setup, I&A (Identity and Access) management, and full application submission including reassignment of benefits to your practice TIN.
Paper-Based Enrollment (Form 855)
For providers who prefer or require paper enrollment, we complete and submit the appropriate CMS-855 form (855I for individuals, 855B for groups, 855S for DMEPOS). We track paper applications directly with the Medicare Administrative Contractor (MAC).
Medicare Revalidation
Medicare providers must revalidate every 3 to 5 years. We manage the full revalidation cycle, including early outreach 90 days before the CMS deadline, document collection, PECOS updates, and submission tracking.
Medicare Advantage Credentialing
Medicare Part B enrollment does not automatically include Medicare Advantage panels. We credential and enroll providers separately with each target MAO including UHC Medicare Advantage, Humana, Aetna, and regional plans.
Group Practice Medicare Enrollment
Multi-provider group enrollment under a single TIN with individual provider reassignment of benefits. We also manage changes to existing groups including new provider additions, location changes, and ownership changes.
DMEPOS Supplier Enrollment
Medicare enrollment for durable medical equipment, prosthetics, orthotics, and supplies suppliers including Form 855S completion, surety bond confirmation, and supplier standards compliance verification.
Why Medicare enrollment requires specialist expertise
CMS processes Medicare enrollment applications through 12 regional Medicare Administrative Contractors (MACs), each with slightly different processing norms, preferred documentation formats, and escalation contacts. What works efficiently at Novitas Solutions in the JH jurisdiction may not be the fastest approach at CGS Administrators in the J15 jurisdiction.
Beyond MAC-specific knowledge, Medicare enrollment has multiple form types, strict legal requirements around reassignment of benefits, and complex rules around ownership and managing control that apply to group practices and medical organizations. Errors in these areas do not just delay the application, they can trigger compliance reviews.
Our Medicare enrollment specialists have processed applications with every MAC and know the specific nuances of each regional contractor. That knowledge is the difference between a 60-day approval and a 120-day back-and-forth with CMS.
From PECOS setup to PTAN in hand
Medicare enrollment questions answered
How long does Medicare Part B enrollment take through PECOS?
CMS publishes a standard processing timeline of 60 days for electronic PECOS applications. Paper applications via Form 855 typically take 90 to 120 days. Timelines can extend due to development letters requesting additional information. Our proactive MAC follow-up minimizes delays by ensuring quick responses to any CMS requests.
What is a PTAN and when will my provider receive one?
A PTAN (Provider Transaction Access Number) is the unique Medicare identifier assigned by CMS after enrollment approval. It is issued with the approval notice and is required to submit Medicare Part B claims. Providers typically receive their PTAN within the CMS processing window after a complete application is submitted.
Does Medicare enrollment cover Medicare Advantage plans automatically?
No. Medicare Part B enrollment and Medicare Advantage credentialing are separate processes. Being enrolled in Medicare Part B means you can bill fee-for-service Medicare, but to participate in Medicare Advantage networks (UHC Medicare Advantage, Humana, Aetna Medicare, etc.) you must apply to each MAO separately.
What happens if a provider misses Medicare revalidation?
Missing a Medicare revalidation deadline results in automatic deactivation of Medicare billing privileges. This means claims will be rejected until the revalidation is completed and CMS reinstates the provider. Reinstatement after deactivation takes additional time and is far more disruptive than completing revalidation on schedule. We track all revalidation deadlines for our active clients and begin the process 90 days in advance.
Can you handle Medicare enrollment for locum tenens providers?
Yes. Locum tenens billing has specific CMS rules. Under the locum tenens provision, the patient physician can bill for services performed by a substitute physician under certain conditions. We advise on the proper billing approach and ensure enrollment is structured to support locum arrangements compliantly.
Do you handle Medicare opt-out applications?
Yes. For providers who choose to opt out of Medicare rather than enroll, we prepare and submit the required affidavit to the MAC and ensure all required private contracts are properly executed. We also advise on the implications of opt-out versus enrollment for different practice types and patient populations.
Ready to start your Medicare enrollment?
Contact our Medicare enrollment specialists today. We will review your provider situation, identify the right enrollment pathway, and give you a clear plan for getting your PTAN as quickly as possible.