Target audience: Medicare fee-for-service providers

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The provider enrollment gateway can be used as a secure mechanism for providers and suppliers to upload paper enrollment applications, submit responses to development requests for an application submitted through the gateway, request a copy of enrollment correspondence for a paper application submitted through the gateway, or to check the status of a previously uploaded paper application submitted through the gateway. It also provides an alternative for providers and suppliers unable to utilize PECOS web or those that have automated processes for pre-populating paper enrollment applications from their credentialing databases. The gateway accepts only the following paper enrollment application types in PDF form:

• CMS-855A for Institutional Providers
• CMS-855B for Clinics/Group practices and Certain Other Suppliers
• CMS-855I for Physicians and Non-Physician Practitioners
• CMS-855O for Eligible Ordering and Referring Physicians and Non-physician Practitioners
• CMS-20134 for Medicare Diabetes Prevention Program Suppliers
• CMS-460 Medicare Participating Physician or Supplier Agreement

Note: The provider enrollment gateway will only accept the application types listed above. The provider enrollment gateway will reject the following stand-alone submissions that are not submitted as part of the PDF enrollment application package (which include but are not limited to): EDI applications, opt-out affidavits, appeals (corrective action plan (CAP), and reconsideration.