Extra Time for Paper Enrollment Applications

The Centers for Medicare & Medicaid Services (CMS) made changes in provider timeliness standards for physicians, non-physician practitioners (NPPs), and other suppliers who submit paper Medicare enrollment applications to carriers and Part A and Part B Medicare Administrative Contractors (A/B MACs).

The revised provider enrollment processing timeliness standards are for certain Medicare enrollment applications. These applications include:

  1. CMS-855I initial application;
  2. CMS-855B initial applications; and
  3. change requests and reassignments.

These timeliness standards do not affect Internet-based Provider Enrollment Chain and Ownership System (PECOS) enrollment applications or Part A providers.

Although CMS encourages timely application processing, these revised processing standards give physicians, NPPs, and other suppliers more time to respond to Medicare contractor development requests when necessary.

MLN Matters MM6807 summarizes the timeliness standards:

“Medicare contractors shall process 80 percent of all initial CMS-855I applications where no contractor development is needed within 60 calendar days of receipt, and 95 percent of such applications within 90 calendar days of receipt. (Development refers to the need for the Medicare contractor to contact the provider for additional information.) In addition, contractors shall process 80 percent of all initial CMS-855I applications where one development request is made by the contractor within 90 days of receipt; and the contractor shall process 70 percent of all initial CMS-855I applications where at least two development request are made by the contractor within 90 calendar days of receipt.

For 855B initial applications submitted by suppliers other than independent diagnostic testing facilities (IDTFs), Medicare contractors shall process 80 percent of these applications where no contractor development is needed within 60 calendar days of receipt , and 95 percent of such applications within 90 calendar days of receipt. In addition, contractors shall process 80 percent of all initial CMS-855B applications where one development request is made by the contractor within 90 days of receipt; and the contractor shall process 70 percent of all initial CMS-855B applications where at least two development requests are made by the contractor within 90 calendar days of receipt.

For initial 855B applications submitted by IDTFs, Medicare contractors shall process 70 percent of such applications where no contractor development is needed within 90 calendar days of receipt, 80 percent of such applications within 120 calendar days of receipt, and 95 percent of such applications within 180 calendar days of receipt.”

For more information on paper enrollment timeliness standards, see CMS Transmittal CR 6807.

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