Last Modified: 1/28/2014 Location: FL, PR, USVI Business: Part A, Part B
Documentation requirements for physician and non-physician practitioners
The Centers for Medicare and Medicaid Services (CMS) has established specific criteria for determining the eligibility of physician and non-physician practitioners for enrollment in the Medicare program and reimbursement for services furnished to beneficiaries.
To ensure CMS’ eligibility requirements are met, the Medicare administrative contractor (MAC) assigned to the practitioner’s jurisdiction may require proof of eligibility to be submitted in addition to his or her initial enrollment, revalidation, or change of information (in select cases) application. For changes to an existing enrollment record, a practitioner should submit only those documents applicable to the change.
Note: Request and obtain your National Provider Identifier (NPI) number before enrolling or making a change to your Medicare enrollment record. If you do not have an NPI, you may request one through the National Plan & Provider Enumeration System (NPPES) website or by calling 1-800-465-3203 (TTY: 1-800-692-2326).
As the MAC assigned to jurisdiction 9 (J9), First Coast Service Options Inc. (First Coast) is responsible for processing provider enrollment applications for providers located in Florida, Puerto Rico, and the U.S. Virgin Islands. To expedite the processing of each provider enrollment application, First Coast recommends that practitioners submit documentation supporting eligibility for enrollment at the same time the application is submitted. Taking this proactive step will facilitate the processing of your application by preventing avoidable processing delays caused by “development requests” (e.g., requests to provide documentation supporting eligibility).
All physician and non-physician practitioners must meet all state licensure and Medicare requirements during the 30 days prior to the submission of their enrollment application and have no final adverse legal actions. For specific guidance regarding qualifications or which support documentation may be required for your provider/supplier type, please click the link describing your profession or specialty from the list shown below.