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May 16, 2019

What to Expect When Enrolling

To better serve the provider community, CGS Provider Enrollment Management Team created an informational guide to the enrollment process that explains what happens after a CMS Medicare enrollment application is submitted.  The “What to Expect When Enrolling”PDF guide delivers the answer as well as needed information for every step of the enrollment process.

This guide explains the provider enrollment process from the contractor’s perspective and gives providers an easy to follow guideline to the enrollment process.  This tool will:

  • Simplify the enrollment process by eliminating industry jargon
  • Use easy to understand terms to explain steps within the process
  • Convey general processing timeframes  to minimize status inquiries early on in the application processing period

This guide also introduces CGS’ 4Rs of enrollment and provides an interactive view of both provider and contractor actions in the order they are performed.

CGS’ 4Rs of Enrollment – RECEIVE, REVIEW, RECONCILE, RESOLVE

Although complex, the enrollment process can be summarized in these four basic categories - RECEIVE, REVIEW, RECONCILE, RESOLVE.   These categories are common terms whose meanings rarely change regardless of the industry or context they are used.   To draw a comparison, we give an explanation of what each one means as it relates to the Medicare enrollment.

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The guide offers timelines for the various application types:

  • When your CMS application is a Paper application that does not require clarification, corrections, or a response to the contractor’s request for more information
  • When your CMS application is a Paper application that does require clarification, corrections, or a response to the contractor’s request for more information
  • When your CMS application is a Web application that does not require clarification, corrections, or a response to the contractor’s request for more information
  • When your CMS application is a Web Paper application that does require clarification, corrections, or a response to the contractor’s request for more information
  • When your CMS application is a Paper or Web 855A or 855B Initial or CHOW for certified providers and requires approval from CMS regional office. 

As we continue to share this new tool with our provider community, we anticipate an increase in applications that do not require clarification, corrections, or a response to the contractor’s request for more information.  Moreover, we foresee usage of this tool causing a decrease in calls to our provider contact center, as well as a decrease in status inquiries.   

To view the average processing times for your application type, refer to the applicable resource below for your provider type.

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