Certified Provider Enrollment Process Loop

Palmetto GBA strives to provide excellent customer service and would like to provide insight into the Certified Provider Enrollment Process. The process detailed below applies to all Part A certified provider types enrolling using the Centers for Medicare & Medicaid Services (CMS) Form 855A, and Part B Portable X-Ray and Ambulatory Surgery Center (ASC) providers enrolling with CMS Form 855B.

The certified enrollment process has five separate and distinct steps.

Step 1 — Submit Application to the Medicare Administrative Contractor (MAC)

The processing time varies by submission method:

• Paper: Approximately 65 days
• Web: Approximately 30 days

A certified provider's CMS-855 application is required to go through a multistep review process. Medicare Administrative Contractors (MACs) are responsible for the initial review of the application. This step consists of intake, screening, verification, fingerprints (if applicable), and a referral to the State Agency (SA) for further review. 

You can submit your completed CMS Form 855A to Palmetto GBA for review and processing by selecting one of the methods below:

• Paper application (click here to access paper enrollment applications) 
• Electronic application via Provider Enrollment, Chain, and Ownership System (PECOS)

Upon receipt you will be notified that we have your application and provided with an Entry Number for monitoring the progress of the application, using our website or Interactive Voice Response (IVR) system. A complete review of your application will be completed and if there are deficiencies or missing supporting documentation, a development letter will be issued to the contact person identified on the application. Requested information should be provided back to Palmetto GBA within 30 days to prevent the application from being rejected for non-response.

Once the application processing has been completed, Palmetto GBA will issue a recommendation for approval letter to your local state agency (SA) and the appropriate CMS Regional Office (RO).

Step 2 — State Agency Processing

The processing time is approximately 45 days once a complete packet is received by SA, including survey requirements. This may vary by SA. Budget limits for each program may dictate what the SA is able to process.

With the MAC's initial review complete, the SA (or an Accrediting Organization [AO], if applicable) will review the application received from the MAC. The provider will receive a referral letter when the application is forwarded from Palmetto GBA to the SA or AO for review, which includes the contact information for the SA/AO. The SA reviews the application for further compliance and state required actions (e.g., certification survey).

What does the state and regional office do with your application?

• Please check your state (XLSX) for information regarding the enrollment process
• The state will:
  • Conduct a survey of the site
  • Validate your accreditation

Once the state completes its review process, a completed packet will be sent to the Regional Office (RO) for review and final approval.

Note: Step 2 will vary by application type.

• Initial applications: If there is AO involvement, the AO will conduct their review and send their response directly to the SA, who then notifies the MAC 
• Changes of ownership or information: Either the SA or the AO may send notification to the MACs to continue processing

The SAs are the primary point of contact for status updates for step 2. 

Step 3 — The MAC Reviews the Application 

The processing time varies if a site visit is required.

• Site visit not required: Approximately 10 days
• Site visit is required: Approximately 45 days

The MAC is notified by the SA/AO once their review is complete. Within 10 days of receipt of this notification from the SA/AO, the MAC will either:

• Send the application to CMS Provider Enrollment
• If required, order a provider enrollment site visit

If a site visit is required, the MAC will send the application to CMS Provider Enrollment after the results are received. The MACs are the primary point of contact for status updates. The MAC will send the application to CMS Provider Enrollment after the results are received. 

Step 4 — CMS Provider Enrollment Reviews the Application 

The processing time is approximately 30 days.

Palmetto GBA will send the application to CMS Provider Enrollment for review. CMS Provider Enrollment will assign the CMS Certification Number (CCN) and effective date, execute the provider agreement, and update the national certification database. When the application is at this step, the provider can contact CMS via the Medicare provider enrollment mailbox.

Step 5 — Palmetto GBA Issues the Final Approval Notification

The processing time is approximately 3 to 10 days.

Once approval is received from CMS Provider Enrollment, Palmetto GBA will send the provider the final approval letter with copies to the SA/AO. The letter will include the provider enrollment and certification information, including the signed provider agreement. Providers should carefully review the final letter as it contains specific information, such as the time frames for any further actions required by the provider and the relevant contact information. At this step, Palmetto GBA is the primary point of contact.

Who to Contact

Medicare Administrative Contractor (MAC)

• General application status 
• Development for additional information 
• Status of the final letter or requesting copies 
• Status of applications returned to the MAC by the SA/AO General provider enrollment issues or questions
• Contact: Medicare Fee-for-Service Provider Enrollment Contact List (PDF)

State Agency 

• Status of licensure Scheduling Survey 
• Status of application referred to the SA 
• Status of initial application survey 
• Status of state survey Plan of corrections for surveys conducted by the State
• Contact: Refer to the notification letter from the MAC or Palmetto GBA

Accrediting Organization 

• Status of survey when the provider seeks a deeming option in lieu of SA survey 
• Contact: CMS-Approved Accrediting Organizations (PDF)

Provider Enrollment at CMS 

• Non-response from MAC or SA on prior inquiries 
• Status requests 
• Contact: MedicareProviderEnrollment@cms.hhs.gov

Resources

• Enrollment & Certification Roadmap for Institutional Providers (PDF)
• Jurisdiction J Part A Provider Enrollment
• Jurisdiction M Part A Provider Enrollment
• Jurisdiction M HHH Provider Enrollment