Enrolling a Physician Assistant with Medicare is a little different than with other eligible healthcare providers.  PA’s don’t actually enroll directly with Medicare, but file an employment arrangement with a physician or medical organization.  The enrollment form used is the CMS855I or the online PECOS system.  Sections 1, 2, and 3 of the 855I are completed in full.  Section 2E is where you list the employer the PA is working for and will be re-assigning benefits.  This form is all that is needed to enroll a Physician Assistant with Medicare.

Qualifications to enroll with Medicare include:

  • Licensed by the state in which the PA practices
  • Graduate of an accredited PA education program OR have passed the national certification examination administered by the National Commission on Certification of Physician Assistants

Documents required to be filed with your CMS855I include:

  • Copy of diploma from accredited education program
  • Copy of state medical license
  • Driver’s license (occasionally required by various Medicare Intermediaries)
  • Marriage license (if the name your are filing is different from what is on file with the Social Security Administration)
  • U.S. Passport (if you were born outside of the U.S. and never before enrolled with Medicare)
  • Other documents may be required depending on your MAC Jurisdiction requirements or special circumstances

Application processing typically takes 60 days or less for most Medicare Intermediaries.  Your effective date with Medicare will be either thirty days prior to the date your application was received or the first date that you saw a Medicare patient, whichever is later.

Health plan enrollment application processing can be time consuming and requires great attention to detail.  Regular follow up after application submission is a necessity to ensuring applications are processed timely.  Requests for additional information to support an enrollment application are required to be submitted timely or the application will be rejected.  Rejected applications must start over and lose the original submission date as the providers effective date.

For help with all your payor enrollment needs, call nCred to discuss how our services can benefit your practice.