Medicare & Medicaid Provider Enrollment

Medicare & Medicaid Provider EnrollmentPresented byZabeen Chong, DirectorProvider Enrollment & Oversight GroupCenter for Medicare & Medicaid ServicesCharles Schalm, Deputy DirectorProvider Enrollment & Oversight GroupCenter for Medicare & Medicaid Services2 Session Overview How Enrollment Works Medicare Policy Updates Medicaid Enrollment Revalidation Our Enrollment Systems Protecting the Program Enforcement ActionsFirst thoughts3 Listening to youFinding a balanceAlways improvingWe hear you, and we ve learned a lot from believe Enrollment should be easyfor most providers, and hardfor bad will keep refining our systems, policies, transparency, and our Enrollment works4 How Enrollment works5* If the app is complete, and no site visitOnline45 days*Direct Input855 Form 60 days*Submission1 MAC mail room Manual data entryIntake2 PECOSP rocessing, Screening& Verification3 Pre Screening signed + dated app fee (or waiver) supporting docs all data elementsRisk Based Fingerprints Site VisitsVerification Name / LBN SSN / DOB NPPES Address License Adverse Actions4 Development Letter 5 Update claim system MAC updates claim system (1-2 days) Provider not approveduntil claims updatedMAC Recommendation to State /RO Certified providers/suppliers MAC recommends to RO RO performs in 3-9 moFinalization& Claims Update6 Submit to MACM edicare Providers &Suppliers(w/NPI)What causes delays?

Oct 01, 2016 · For information on which actions trigger the application fee requirement by provider/supplier type refer to the Application Fee Matrix on CMS.gov. Refer to SE1617 for reporting requirements xisting information with new information Replace e (ex. practice location, ownership ) Update existing information (ex. change in suite #, telephone #)

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  Medicare, Medicaid, Provider, Enrollment, Medicare amp medicaid provider enrollment

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