Medicare Provider Number Application Tips

The Medicare Program is a health insurance program of the U.S. Government.  U.S. citizens and permanent residents are eligible for Medicare coverage if they (or their spouses) worked 10 years or more in employment covered by Medicare and are at least 65 years old.

Additionally, persons less than 65 years old can be covered by Medicare benefits if they are disabled or have end-stage renal disease requiring either kidney dialysis or a transplant.

Before Medicare patients can be accepted by a health care provider, however, it is necessary for the provider to submit a Medicare application.

Below are some tips for a health care provider to get faster approval of its Medicare application.

Medicare coverage and information is subject to change without notice. Always check with your local Medicare professional for the most recent information.

1.  Obtain A National Provider Identifier (NPI) Before Applying

Health providers must supply a valid NPI on the Medicare application.

2.  Health Providers and Suppliers Should Submit The Most Recent Version

The Centers for Medicare & Medicaid Services (CMS) revised the CMS-
855 Medicare enrollment applications starting May 1, 2006.  Health care providers must complete that version of the form at the time of this writing.  The Medicare application version is located in the lower left-hand corner of the form.

3.  Health Providers and Suppliers Should Submit The Proper Form Type

The Medicare application form differs for each type of health care provider.  For example, a doctor’s office, ambulance provider, and mental health care institution would each submit a different version of the form.  Each provider’s form lists the types of providers that can utilize it.

4.  Include All Supporting Documentation

All requested records must accompany the completed Medicare application.  These records may include professional and business licenses, identification numbers, and other professional documents.

5.  Make Sure Your Application Is Complete

Submitting an incomplete Medicare application requires the agency to either contact you for the missing information, or return the form for completion.  Save time by supplying all information the first time.

6.  Health Providers and Suppliers Should Submit To The Proper Place

Different contractors process the Medicare application from different parts of the country.  Submitting the completed form to the wrong address will delay the enrollment.

7.  Include All Application Fees If Required

Certain institutions must include a Medicare application fee.  The provider must include all information to pay this fee via electronic transfer.

8.  The Responsible Official Must Sign And Date The Form

The Medicare application process for providers can sometimes be difficult, so failure to sign and date the form is a common mistake.

9.  Handle Medicare Application Information Requests Promptly

The contractor handling a provider’s form may have questions.  Prompt responses can keep the application process going.

Most health care providers can get their Medicare application approved faster if they follow a careful and methodical approach to completing the enrollment form.

101 Responses to Medicare Provider Number Application Tips

  • Dolores says:

    I’m a NYS Licensed RN and hold a PhD in Naturology (natural and preventative health), Certified as Personal Trainer/Certified Sports Nutrition, and Certified Facial Provider.

    My private business is Lifestyle & Weight Management (nutritional counseling, personal training exercises, and stress reductions, which includes diode light and cleaning facials and nurse’s simple body massage prior to or after an exercise session). I do hold mal practice insurance for both RN and Lifestyle & Weight Management Counselor through my nursing ins. provider, and I use a small storefront as my private fitness studio.

    Would I be able to obtain a provider number for RN/Fitness Provider/Counselor? The NYS BOE for Nurses said I must have a doctor’s order from the clients, which is not a problem. My prospective clients are requesting that I take their medicare and/or private insurance to cover the costs of the counseling. Most of my target population are over 45 yrs of age.

    Thank you for your assistance.

Leave a Reply

Your email address will not be published. Required fields are marked *

Search Now!

Free Medicare Guide!