Medicare credentialing

 All the providers must be credentialed with Medicare before start billing for their services. Group practices and the providers within the group must be separately credentialed and linked together to start billing. All the enrollment applications must be submitted to the corresponding MAC (Medicare Administrative Contractor) for the state.

MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims. 

 CMS wants providers to use the online Medicare enrollment system called PECOS. All the submitted enrollment applications will be forwarded to the corresponding MACs which pre-screen and verify enrollment application information. During application processing, your MAC may need additional information that has to be submitted with in the requested time otherwise the application will get rejected.

 Medicare Credentialing check list for providers, NPs, and group practices:

  • Active NPI
  • Active state license and DEA certificates
  • Copy of board certification
  • IRS letter confirming the legal business name



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