Medicare Provider Enrollment, Handled End-to-End

Medicare enrollment is processed through PECOS, the Provider Enrollment, Chain and Ownership System, by a regional Medicare Administrative Contractor, or MAC, assigned to your state. Your file is reviewed against your NPI registration, your state licensure, and any ownership or managing-control disclosures. Once approved, the MAC issues a Provider Transaction Access Number, or PTAN, and an effective date that determines when you can begin billing.

The system is unforgiving of inconsistency. The legal business name, the practice address, and the tax identification number must match exactly across your NPI record, your application, and your reassignment. We reconcile all of these before submission so the MAC has no reason to develop your file or return it for correction.

Choosing the wrong form is the most common reason a Medicare file stalls before it is even reviewed. We select and complete the correct application for your situation:

• CMS-855I — individual physicians and non-physician practitioners enrolling to bill Medicare.
• CMS-855B — clinics, group practices, and other organizational suppliers.
• CMS-855R — reassignment of a provider's benefits to a group or employer that will bill on their behalf.
• CMS-855S — durable medical equipment, prosthetics, orthotics, and supplies suppliers.
• CMS-855O — enrolling solely to order, certify, or prescribe, without billing privileges.

When a provider bills under a group's tax ID, Medicare requires a reassignment on the CMS-855R linking the individual to the billing entity. For group practices and facilities, this is where enrollment gets complicated — each provider must be individually enrolled and then reassigned to every location and TIN they will bill under.

We map your provider roster against your billing entities, file the reassignments in the correct sequence, and confirm each link is active in PECOS before you submit a claim. When a provider leaves, we handle the termination so an inactive reassignment does not trigger an audit flag.

Most delays are avoidable. The patterns we see most often are mismatched practice or pay-to addresses between your NPI and your 855, missing or unsigned certification statements, incomplete ownership and managing-control disclosures, an unpaid application fee for institutional enrollments, and unresolved adverse legal history that was not addressed up front.

When a MAC has a question, it issues a development request with a short response clock — often around 30 days. Miss it and the file is rejected and you start over. We respond to development requests on your behalf, fast, with the documentation already organized.

A clean electronic 855 submission typically processes in roughly 30 to 90 days, though complex group enrollments, reassignments across multiple TINs, and any file that triggers a development request can run longer. Site visits for certain supplier and institutional enrollments add time as well.

Medicare also allows retrospective billing for a limited window before your effective date in many situations, which can recover revenue earned while your file was pending. We pursue the earliest defensible effective date so the calendar works for you, not against you.

Every Medicare-enrolled provider and supplier must revalidate their entire enrollment record on a five-year cycle, and MACs can also issue off-cycle revalidation requests. Miss the deadline and your billing privileges can be deactivated, which means denied claims and a scramble to reactivate.

We calendar your revalidation date the day you are approved, monitor for off-cycle notices, and complete the full revalidation through PECOS ahead of the deadline. Your status stays active and your cash flow stays uninterrupted.