To become a Medicare provider in the state of California, you must apply online at the website of the United States Department of Health and Human Services.The only way to become a Medicare provider in the United States is through the online application process.Within 60 days of submitting the application, the California Medicare Administrative Contractor will notify you of your official status as a Medicare provider.The process takes time, but the care you give those patients who are Medicare beneficiaries is essential to making California and its residents healthy, happy, and productive citizens.
Step 1: There are different types of Medicare.
Any physician or non-physician medical care or supply provider who offers services or goods necessary for the physical and mental health of those who receive Medicare coverage are eligible to apply.The application process includes a number of steps to make sure you are eligible.It is important to review the various types Medicare coverage and how your clinic, practice, hospital, home health, or medical equipment provider fits into each part.Hospital treatments, long-term care facilities, home health, and Hospice are included in Part A.Part B, or medical treatment Medicare, covers doctor services, preventive care, medical equipment, any outpatient procedures, lab testing, x-rays, clinical and outpatient mental health services and other similar treatments.Private insurance providers offer Medicare coverage.If you want to expand the services and providers included in your treatment plans, you can opt for the Part C plan.Part D deals with prescription drugs.
Step 2: There are additional paperwork for specialty care or suppliers.
Home Health and Hospice providers are required to provide extra information or apply through different agencies if they want to sell Durable Medical Equipment Prosthetics/Orthotics.Make sure you don't offer any of the services that may be included in these two areas before you submit your application.In order to bill Medicare for the goods provided, additional criteria must be completed by the suppliers.Home Health and Hospice providers will need to complete additional paperwork.When you identify as a Home Health or Hospice provider, these will be added to the PECOS application.Home Health and Hospice providers will receive Medicare provider approval through a different set of MACs than those that cover the other parts of Medicare.
Step 3: Determine if you are a Medicare provider.
A variety of medical providers and suppliers are recognized by Medicare to meet the health needs of its beneficiaries.State licensing regulations determine eligibility for Medicare.In order to be approved as a Medicare provider or supplier, you will need to meet licensure regulations and legal authorizations to practice in the state of California, your county, city, and other local.You will need to be licensed to practice medicine in order to do so.
Step 4: The National Plan & Provider Enumeration System allows you to register.
If you want to become a Medicare provider, you will need to log into thePECOS website with a user ID that will be used to obtain your National Provider Identifier.The process is simple, but you cannot change it once you have chosen a user ID.Evaluate the information before making a final decision.
Step 5: Obtain your NPI.
You will need to request the provider number once your user name is set up.Depending on the type of medical care you provide, you will need to obtain an individual, organizational, or both types of NPI before you can apply as a Medicare provider.Individuals applying to accept Medicare must have type 1 NPIs.It is necessary for organizations to have type 2 NPIs in order to approve individual providers.If you are the sole proprietor of a medical facility, you need both types of NPI.
Step 6: You can apply through thePECOS.
In order to accept Medicare payment in the state of California, you must be approved by the federal government.A clearly defined question and answer application is set up for the process.The Centers for Medicare and Medicaid Services has a list of checklists for each type of Medicare provider.If you have a question during the application process, the representative can be reached via email or phone.
Step 7: All the necessary documents should be included.
Make sure you include all the necessary documentation in your application.The Medicare application process can take three months or longer, and each time you need to submit additional documents, the processing time is reset.The PECOS system will walk you through each step of the process and give you the forms and documents you need.Your tax ID number and legal business name are provided in a written confirmation from the IRS.A letter of determination from the IRS is required for non-profits.You need an IRS letter to confirm that the business entity is not separate from the individual for tax purposes.Final adverse action documentation from legal cases against you or the practice you work for.If you have an agreement with a bank to cover pending Medicare payments, you should include banking information.Drug Enforcement Administration numbers are included in the approval documents for each location, provider, and supplier.
Step 8: Request additional information quickly.
You will be contacted if you miss something.Ensure your application process is completed in a reasonable time frame by returning additional information as quickly as possible.You can check the status of your application online through the PECOS system, if additional information is needed, but you should receive emails directly.
Step 9: Pay the fee.
You will need to pay an application fee to exit the PECOS system.The cost was $560 in 2017, but the fee is adjusted annually.The application fee is used by Medicare to finance ongoing improvement efforts to ensure the integrity of the Medicare system.
Step 10: The forms for file electronic data interchange.
The Administrative Simplification Compliance Act states that Medicare claims should be filed electronically.Some providers have been granted exceptions.Medicare providers can directly submit claims through the edi system.Before you can be approved by the state of California Medicare Administrative Contractors, you need to have completed the process of registration.
Step 11: PECOS documentation should be sent to the appropriate California Medicare Administrative Contractor.
The Centers for Medicare and Medicaid Services has delegated jurisdiction of their providers in specific geographic regions to a number of private medical care insurers.Once your Medicare application is approved by the Centers for Medicare and Medicaid Services, they should submit the documentation to your MAC.You can see your progress on the PECOS system.Noridian and National Government Services will approve your application.Noridian gives approval for providers of Medicare Part A and Part B in the state of California.National Government Services handles applications for Home Health and Hospice providers in the state of California.
Step 12: Supporting documents can be sent to the California MAC.
You will be prompted to print out a certification statement within the PECOS online application system, and you will need to sign and send the statement along with a copy of your California clinical license to the appropriate MAC.To be considered for approval as a Medicare provider, you need to send the documents to the California MAC within 7 days of completing the PECOS application.
Step 13: Ask for additional documentation.
Even though your application has been submitted, your MAC may require additional documents or information to complete the application process.The more quickly you can respond to document requests, the quicker your application process will continue.You may be asked to provide IRS documentation, proof of identity, licenses, or other information in order to determine your eligibility.
Step 14: You must pass site visits.
A site visit is required if you are applying as a Medicare provider on behalf of a clinic, hospital, long term care or other medical facility.National site visit contractors conduct site visits.All site inspectors for Medicare providers in the US will be employed by MSM Security Services, or their subsidiaries.At the time of inspection, site inspectors will present valid ID from one of the companies.Failure to cooperate with the site inspectors can lead to rejection or revocation of Medicare provider status.The additional CLIA qualification is already met by the suppliers so a site visit is not required.
Step 15: Wait for your approval letter from the MAC.
Within 45 to 90 days, you will receive electronic verification from the appropriate MAC, which will let you know if your application was accepted or rejected.If you have been approved as a Medicare provider, you will get a Provider Transaction Access Number.Your individual PTAN will be associated with your NPI number and will allow you toauthenticate yourself within the Medicare system.
Step 16: Enroll in Electronic Fund Transfer for Medicare.
The ASCA requires documentation to be filed electronically, as well as paying Medicare claims electronically.Once you have been approved as a Medicare provider, you should complete the EFT form included in the packet.If you didn't get the form, contact your MAC.