Medicare Credentialing- The In’s and Out’s

Medicare seems to make life difficult for providers nationwide when it comes to credentialing, regardless of your provider type. Luckily, Rush Credentialing is ready to give you some tips.

Here is a list of the different provider enrollment applications we will be focusing on:

• 855I Application
• 855B Application
• 588 EFT Application
• 460 Par Agreement

These all can be found at the www.cms.gov website for use (Link: https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers)

These applications can be submitted via the Pecos portal, or by mailing in paper applications. Either way is fine. Medicare will quote a processing time of up to 120 days…however we consistently receive approval letters right around 45 days. Remember, these approval will come with a 30 days backdated effective date.

Let’s go through each one and lists what it would be use for:

• 855I: This application enrolls a provider, and/or links them to an existing group practice. Provider will obtain a PTAN #.
• 855B: This application enrolls an outpatient healthcare group. The group will obtain a Group PTAN #. In order to enroll the group though, a rendering provider is required to be linked to the group at the same time.
• 588 EFT: This application sets up the EFT Enrollments for the business. Medicare requires all provider’s and groups to be paid by direct deposit.
• 460 Par Agreement– This Agreement is used when the provider or group wants to be listed in the Medicare system as participating. Provider’s and groups not wanting to be listed as Par, can still enroll with Medicare, they just don’t submit this agreement with the enrollment packet.

Now here is a list of some supporting documents a provider or group will want to submit with the applications:

• Provider State License
• Provider DEA License (if applicable)
• Provider Board Certificate (if applicable)
• IRS CP575G form
• Business Voided Check or Bank Verification Letter
• Provider Certificate of Professional Insurance
• Provider Graduate Diploma or Degree
• Type 2 NPI# for the business

We trust this information will be beneficial to you. However, if you require further assistance, feel free to reach out to us at www.rushcredentialing.com. We’re eager to assist with your Medicare credentialing needs.