You may be eligible to participate as a Medicare
Participating provider. If you are enrolling as a new entity (even if
you are a participating provider under an existing or previous
provider number) and wish to be a participating provider, the
following Participating Physician or Supplier Agreement must be
reviewed and completed.
A Medicare Participating Provider enters into an
agreement with the Medicare Program to accept assignment of Medicare
Part B payment for all services for which the provider is eligible to
accept assignment under Medicare law and regulations.
A Medicare Participating Agreement is in effect through December 31st following the date the agreement becomes effective. An agreement received with an application will be effective on the date of filing, i.e., the date the
participant mails (postmark date) the agreement to the carrier or delivers it to the carrier. The agreement will be renewed automatically for each 12-month period beginning January 1st through December 31st.
You do have 90 days from the time you are assigned a
Medicare billing number to be a participating provider. But, if you
decide to be a participating provider after your Medicare billing
number is assigned, the effective date will be the postmark date of
the envelope received with the Participating Physician or Supplier
Agreement. If your agreement is postmarked after 90 days it will
voided and you will be required to wait for the Medicare Participating
Open Enrollment (November 15 – December 31st) to enroll as
a participating provider.
Individuals joining an established participating
provider, the decision to participate has already been made for the
current year and you should not complete the form.
The following practitioners must accept assignment
for all Medicare covered services and are not required to complete the
form:
- Certified Nurse Midwives
- Certified Registered Nurse Anesthetists
- Clinical Nurse Specialists
- Clinical Psychologists
- Clinical Social Workers
- Nurse Practitioners
- Physician assistants
If you decide to participate, you will be sent a
confirmation letter to affirm your participating status in the
Medicare program.
This agreement does not have to be completed in
order to obtain a Medicare provider billing number.
