Wrong form, wrong order
A provider joining a group needs the 855R filed against an approved group 855B. Filing them out of sequence means a return for development and another 30 to 60 days.
Provider credentialing
Medicare Provider Enrollment Services
We prepare and file CMS-855I, CMS-855B and CMS-855R applications through PECOS, chase your Medicare Administrative Contractor until the approval letter arrives, and load your PTAN and effective date into billing.
Medicare enrollment at a glance
- Forms: CMS-855I, 855B, 855R, 588
- Filed through PECOS, not paper
- Typical processing: 30 to 60 days
- Retroactive effective date preserved
- Revalidation date tracked from approval
- CMS-855I/B/R
- individual, group and reassignment forms handled
- Weekly
- MAC status checks on every open application
- All 12 MAC jurisdictions
- Novitas, NGS, Noridian, Palmetto, First Coast, CGS, WPS
The application path we run for this payer
- 1
Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
Medicare enrollment decides whether you can bill Medicare at all, and Medicare is usually the largest single payer in a practice. A rejected or developed application resets the clock, and every week without a PTAN is a week of visits you cannot bill.
ClainetRCM files the right form for your situation, an individual 855I, a group 855B, or a reassignment 855R, through PECOS, and works the application with your MAC until it is approved with the retroactive effective date you are entitled to.
Where this usually goes wrong
Development requests missed
MACs give a short window to answer a request for more information. A missed letter means the application is rejected and refiled from scratch.
Retroactive date lost
Medicare allows a limited look-back on the effective date. Late filing or a rejected application can push that date forward and forfeit billable visits.
What ClainetRCM handles
One coordinator owns the file from intake to effective date.
- Provider and group eligibility check against Medicare enrollment rules
- PECOS account setup, surrogate access and identity verification
- CMS-855I, 855B, 855R and 588 EFT preparation and submission
- Certification statements, supporting documents and application fees
- MAC development responses and status calls on a weekly cadence
- PTAN, effective date and revalidation due date recorded in your billing system
Which Medicare form applies to you
| CMS-855I | Individual physicians and non-physician practitioners enrolling for the first time, adding a practice location or changing information. |
|---|---|
| CMS-855B | Group practices, clinics and other suppliers that bill under a group NPI and Tax ID. |
| CMS-855R | Reassignment of benefits, so a provider's payments go to the group. Required for every provider who joins a group. |
| CMS-855S | DMEPOS suppliers, handled on our DME Medicare enrollment page. |
| CMS-588 | Electronic funds transfer authorization, filed with every new enrollment. |
Once approved, Medicare requires revalidation on a fixed cycle. We track that date from day one; see Medicare revalidation.
Questions about Medicare Enrollment
Clean PECOS applications are typically processed in 30 to 60 days, while paper applications and those returned for development can run 90 days or longer. We file electronically and answer development requests the same business day to keep you at the short end of that range.
You can see Medicare patients and hold claims. Once the enrollment is approved with a retroactive effective date, held claims within that window can be submitted. We track the timely filing limit so nothing ages out while you wait.
The NPI is a national identifier you get from NPPES. The PTAN is the Medicare-specific number your MAC assigns after enrollment. You need both to bill Medicare, and a PTAN is tied to a specific MAC and practice location.
Yes. We work with every Medicare Administrative Contractor, including Novitas, NGS, Noridian, Palmetto GBA, First Coast, CGS and WPS, and we know which jurisdiction covers each of your locations. See the states we serve.
Other payers and enrollment pages
Back to the provider credentialing overview, or continue with a related page.
Medicaid Provider Enrollment Services
State Medicaid and MCO enrollment
PECOS Enrollment and Account Management
Medicare's online enrollment system
Medicare Revalidation Services
Cycle revalidation without deactivation
Insurance Credentialing Services
Commercial and government panels, end to end
Healthcare business registrations
Entity, EIN, NPI and PECOS setup
States we serve
MAC jurisdiction and Medicaid by state
Private practices
Billing and enrollment for independent groups
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
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