To submit your application(s) successfully, gather all necessary documents required to enroll for your provider or supplier type.

1. Download the appropriate application(s).

2. Complete the application(s) electronically and save the application(s) on your computer. 

3. Upload or scan any necessary supporting documentation. 

Note: File names can have letters, numbers, underscore or hyphen only. If another character (such as a comma is used), you will receive an error message like the below when uploading to the gateway.

Supporting documentation may include:

• Licenses, certifications and registrations required by Medicare or state law

• Federal, state, and/or local (city/county) business licenses, certifications and/or registrations required to operate a health care facility

• IRS documentation confirming your tax identification number with the legal business name (e.g., IRS CP 575)

• IRS determination letter, if registered as nonprofit entity

• IRS documentation confirming a limited liability company is classified as a disregarded entity. (e.g., Form 8832)

• Bills of sale or sales agreements (required for change of ownership (CHOW), acquisition/mergers, and consolidations)
• Home health agencies: documentation showing you meet capitalization requirements
• Independent clinical laboratories: Documentation confirming required state licenses or certifications for the laboratory director or non-physician personnel
• Bank offset waiver (if applicable): A written statement from your bank confirming it has agreed to waive its right to offset Medicare payments if you have a lending relationship and Medicare payments are sent to the bank
• Adverse legal actions: Copies of all documentation related to adverse legal actions, including notices, resolutions, or reinstatement letters
• Federally qualified health centers (FQHCs): A copy of the Health Resources and Services Administration (HRSA) Notice of Grant Award, if used to qualify for FQHC status
• Medicare participation agreement (CMS 460): A completed CMS 460 form. This is required for initial enrollments or reactivations only if you choose to participate in Medicare
• Government and tribal entities: A signed attestation confirming eligibility
• Air ambulance suppliers: A copy of the FAA Part 135 certificate
• Independent Diagnostic Testing Facilities (IDTFs):
  • A copy of your comprehensive liability insurance policy
  • Documentation verifying supervisory physician qualifications and required state licenses or certifications for non-physician personnel
• Opioid Treatment Programs (OTPs):
  • A copy of the CMS 1561 Health Insurance Benefit Agreement
  • A copy of the program’s operating certificate

4. Save the application(s) and supporting documentation as one PDF file to upload. Please note that the gateway will only accept files that are in a PDF format for initial submission. File size cannot exceed 50 MB for a single file, or 200 MB total for all files being uploaded.

5. Have your NPI and an email account accessible, as you will be receiving a one-time access code to enter into the gateway.