What Is Healthcare Provider Enrollment


Provider Enrollment refers to the process of requesting participation in a health insurance network as a Participating Provider.  The provider enrollment process involves requesting enrollment/contracting with a plan; completing the plans credentialing/enrollment application; submitting copies of licenses, insurance, and other documents; signing a contract; and any other steps that may be unique to a carrier.


The provider enrollment processing time varies by payor.  When submitting documents for enrollment, it is important to document your steps by utilizing certified mail, overnight mail services, email, fax logs, and documenting phone conversations with agent names and numbers.


Medicare Provider Enrollment

What does the Medicare Provider Enrollment process require?


Medicare provider enrollment can be a time consuming process.  The enrollment process involves submitting the appropriate Medicare Provider/Supplier Enrollment forms such as the CMS-855I, CMS-855B, CMS-855S, and CMS-855A.


Medicare will typically take 60 days to process enrollment applications for individual providers.  Applications for facilities, DME companies, Home Health agencies, Independent diagnostic testing facilities, and other organizations can take longer due to the stringent enrollment requirements including site visits.


There are service companies and software programs that can assist providers and organizations with the Medicare provider enrollment process.  Automating the process can save time and headaches and improve cash flow.  Medicare is an important payor for most medical facilities, so be sure to get your enrollment done correctly the first time and make sure that your Medicare provider enrollment records stay up to date.


Visit Medicare’s Provider Enrollment area on their website for more information about becoming a Medicare Provider.