New physicians, practitioners, and suppliers may submit the CMS-460 form at the time of their enrollment. Participants agree to accept assignment for all covered services provided to Medicare patients.

In addition, the CMS-460 may also be used for existing providers during the annual participation open enrollment. The annual physician and supplier participation period begins January 1 of each year and runs through December 31. The annual participation enrollment is scheduled to begin on November 15 of each year. (Note: The dates listed for release of the participation enrollment/fee disclosure material are subject to publication of the annual Final Rule.)

During the annual enrollment period, for First Coast, the MAC for jurisdiction N (JN), which includes Florida, Puerto Rico, and the U.S. Virgin Islands, submit your completed CMS-460 form (or disenrollment request) to:

Provider Enrollment
P.O. Box 3409
Mechanicsburg, PA 17055-1849

Click here to find web addresses for other MACs/carriers. You can locate their mailing addresses for participation enrollment from their websites.

References:
CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 1, section 30.3.12.1