What are the definitions of "payment floor" and "clean" claim?

Member for

1 year 3 months
Submitted by Catie.Fry@novi… on

The “payment floor” is a waiting period during which time the contractor may not pay, issue, mail, or otherwise finalize the initial determination on a clean claim. There are different waiting periods for electronic claims and paper claims. The waiting periods are 13 days for electronic claims and 28 days for paper claims. However, the payment may not be issued until day 14 (electronic) or 29 (paper).

I cannot find my specialty listed on the application? What should I do?

Member for

2 months
Submitted by Bradley.Bohner on

If your provider type, supplier type, physician specialty, or non-physician specialty type is not listed in the application, please select other, undefined physician specialty, or undefined non-physician practitioner specialty. Then list your type or specialty in the provided field.

I am an ordering and certifying provider already enrolled in one state. What should I do to update my information if I move to another state?

Member for

2 months
Submitted by Bradley.Bohner on

For providers that enroll solely to order or refer services using the CMS-855O, it is a national enrollment. When you relocate to another state, you are not required to dis-enroll from the current state and re-enroll in the new state. The contractor that maintains your CMS-855O enrollment in PECOS is responsible for processing changes of information, including relocating to a state outside of their jurisdiction. 

Reference: 

Are providers in Puerto Rico and the USVI required to submit a letter of good standing with their applications? How far in advance can the letter be dated prior to submission of the application?

Member for

2 months
Submitted by Natalie.Son on

Yes, for initial, revalidation and reactivation applications, a Puerto Rico and/or U.S. Virgin Islands provider is required to submit a letter of good standing with his or her application if there is no online verification source to verify a medical license. The letter of good standing is not required with a change of information application unless it involves a license update/change. 

Voluntary terminations

Read this article for instructions on how to terminate your Medicare enrollment.

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