Turnaround time varies between insurance carriers, so there is no one answer to this question. Major carriers generally take between 90-120 days to complete the process. Smaller carriers and insurance plans may take longer.

Upon submitting a participation request to a commercial carrier, providers will need to undergo two processes. The first of these is credentialing, where the carrier verifies all provided credentials and presents them to their committee for approval. Once providers are approved by the credentialing committee, they are then directed towards the contracting process wherein their participation is approved, and they are provided their effective date.

Commercial carriers do not allow for retroactive billing, meaning providers will only be compensated for claims submitted after they are listed as an “In-Network” provider in the carrier claims system. Out of network billing will result in much larger bills for patients and patients may be responsible for the entire bill on their own.

Applications of enrollment in Medicare typically take between 60-90 days to complete, though this does vary wildly between states. The effective date for Medicare is set as the date the application was received, allowing for providers to retroactively bill for any encounters that occurred between application and approval. There is also a 30-day grace period, enabling providers to bill for service provided up to 30 days prior to their effective date.

Turnaround time is longer for DMEPOS suppliers. In addition to the close scrutiny that every application is subjected, suppliers will also be required to participate in a site visit as part of the application process. The site inspector will be responsible for ensuring the office is located at the address included on the application, as well as hours of operation, where inventory is stored, and other important elements of being a DME supplier.

Sadly, CureMD cannot make the process any quicker. Our contribution is efficiently and effectively managing the entire application process, beginning with initial credentialing applications and carrying through to follow-ups with carriers. Our experts are well versed in the entire process, saving time that might otherwise have been wasted by providers attempting to perform the process themselves and making mistakes along the way.

Yes, it is necessary for providers to have a place of service before they begin the medical credentialing and contracting process. A home address cannot be used as a clinic address, wither permanently or temporarily. A home address can, however, be used as an address for billing or correspondence, but only if a physical address for the practice is also provided. In the event that the office space is still under construction, the address can still be used. The application can be sent up to 30 days prior to the location actually opening up to patients, and most commercial carriers also offer the same guideline.

Revalidation of Medicare enrollment is required every 5 years but DMEPOS suppliers revalidate every 3 years. Individual providers can either complete the CMS855I paper application or use PECOS to complete the revalidation online. For groups or suppliers, the CMS855B application must be completed. If an Electronic Funds Transfer was not previously set up for the group record, one will need to be created for the revalidation process.

Providers must respond to their Medicare carrier within 60 days of receiving their revalidation letter. It is important to respond promptly, otherwise billing privileges will be terminated.

The CMS855I is used for individual provider enrollment in Medicare. It can be used by both physicians and non-physicians. Other necessary documentation will very between provider types.

Providers may also need to submit the CMS460 form to elect for participation in Medicare, without this form provider may be enrolled as non-participating providers. Non-participating providers will receive less reimbursement from Medicare, though they are also entitled to pursue more reimbursement directly from patients; up to 115% of the Medicare rate.

For providers enrolling under an existing group practice, the CMS855R form will need to be submitted. This form reassigns the provider’s financial payments to the business ender which their services are performed.

The CMS588 will be needed for both individual and group practices, in order to setup Electronic Funds Transfer to receive Medicare payments. Medicare does not issue paper checks; reimbursement is only dispensed via ETF.

Summary of applications:

• Solo practitioner forming a new business entity: CMS855I, CMS460, CMS588
• New provider joining an existing group: if already in enrolled with the state intermediary – form CMS855R; if not enrolled with the state intermediary – forms CMS855I, CMS855R
• Form CMS460 may be required for new enrollment depending upon the status of the group/supplier