CMS Issues Ruling on Provider Enrollment

Posted by medpro | Posted in Credentialing, Medical Contracting, Provider Enrollment | Posted on 20-06-2012


As of June 26, 2012, the new provider enrollment rule requires that all providers and suppliers eligible for a national provider identifier (“NPI”) must:

  • Report their NPIs on their Medicare enrollment application;
  • Update their enrollment record if the provider or supplier was in the Medicare program prior to obtaining an NPI or if the NPI is not in the provider or supplier’s enrollment record; and
  • Include their NPIs on all claims submitted to Medicare for payment, and the NPIs of any other provider or supplier identified on the claim.

The anticipated effects of implementing these new rules will result in $1.59 billion in savings over the next ten years.  This is a consequence on  CMS’ aggressive approach to provider enrollment by helping to ensure greater quality and integrity on the front end in the provider enrollment process.

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