PE Gateway Getting Started

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Home ► PE Gateway Getting Started

Last Modified: 10/4/2024 Location: PR, FL, USVI Business: Part A, Part B

Getting started

In order to submit your application(s) successfully, please ensure that you have gathered 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. Supporting documentation includes:

• 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.

• Written confirmation from the IRS confirming your Tax Identification Number with the Legal Business Name (e.g., IRS CP 575) provided in Section 2.

• Copy of IRS Determination Letter, if supplier is registered with the IRS as non-profit.

• Written confirmation from the IRS confirming your limited liability company (LLC) is automatically classified as a disregarded entity. (e.g., Form 8832). (Note: A disregarded entity is an eligible entity that is treated as an entity not separate from its single owner for income tax purposes.

• CMS-855I form if you are a Part B provider or supplier that is newly enrolling, reactivating your Medicare benefits, or adding/changing a reassignment.

• If Medicare payments due to you are being sent to a bank (or similar financial institution) where you have a lending relationship (that is, any type of loan), you must provide a statement in writing from the bank (which must be in the loan agreement) that the bank has agreed to waive its right of offset for Medicare receivables.

• Copy(s) of all bills of sale or sales agreements for all ownership changes. This includes, CHOWS, Acquisition/ Mergers, Consolidations, and all other ownership changes that are required to be reported, regardless of the percentage involved (e.g., new 15 percent owner).

• Copy of all documents that demonstrate meeting capitalization requirements (HHAs only).

• Copy of all documentation verifying the State licenses or certifications of the laboratory Director or non-physician practitioner personnel of an independent clinical laboratory.

• Statement in writing from the bank. If Medicare payment due a provider of services is being sent to a bank (or similar financial institution) with whom the provider has a lending relationship (that is, any type of loan), then the provider must provide a statement in writing from the bank (which must be in the loan agreement) that the bank has agreed to waive its right of offset for Medicare receivables.

• Copy(s) of all adverse legal action documentation (e.g., notifications, resolutions, and reinstatement letters).

• Copy of HRSA Notice of Grant Award if that is a qualifying document for FQHC status.

• Completed form CMS-460, Medicare participating physician or supplier agreement. Note: The CMS-460 must be submitted for all initial enrollments or reactivations only if you want to be a participating practitioner in Medicare.

• Copy of an attestation for government entities and tribal organizations.

• Copy of FAA 135 certificate (air ambulance suppliers).

• Copy(s) of comprehensive liability insurance policy (IDTFs only).

• Copy of all documentation verifying IDTF Supervisory Physician(s) proficiency and/or State licenses or certification for IDTF non-physician personnel (IDTFs only).

• Copy of the CMS-1561 Health Insurance Benefit Agreement (OTPs only)

• Copy of the Opioid Treatment Program’s Operating Certificate (OTPs only)

• Note: If you need to submit the CMS-588 authorization agreement for electronic funds transfer, please submit via mail.

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.

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

First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.