Did you know that half of all enrollment applications are returned to providers for the following errors? Providers are encouraged to review the information below for faster approval.
- Missing or Non-Matching License or Certification Attachment - The license attachment is missing, or the effective dates or end dates provided on the application do not match the documents provided as proof of licensure/certification.
Note: Legal entity information on the application must match the documents provided as proof of legal entity status. - Answer to Supplemental Question (located in the 'Other Information' section) "Do you hold all licenses and certifications as required based on your provider type?" - Providers are encouraged to carefully read each question prior to answering. All enrolling providers must answer this question regardless of license and certification requirements for the provider enrollment type. If licenses or certifications are not required for the provider enrollment type, this question must still be acknowledged.
- National Plan and Provider Enumeration System NPPES Address Mismatch - The address in the National Plan and Provider Enumeration System (NPPES) does not match the service location address on the application.
- W9 Address Mismatch - The address entered on the W9 attachment is required to match the mail to, pay to, or service location address in the application.
- Supplemental Questions (located in the 'Other Information' section) - Provider did not complete this section at all.
- SSN is needed for this provider type - Either provider selected Federal Employer Identification Number (FEIN) for Tax ID type, or they are using the group's Tax ID.
- Incorrect Taxonomy Code - The National Provider Identifier (NPI) and taxonomy code submitted with the provider's enrollment application must match the information on record with the National Plan and Provider Enumeration System (NPPES).
- Medicare Number not verified - When the Medicare number was searched in the Provider Enrollment, Chain, and Ownership System (PECOS), nothing came up for the provider.
- DEA mismatch - Either the name or the United States Drug Enforcement Administration (DEA) number on the attachment do not match the information listed in the application.
- Tax Identification Numbers: Social Security Number (SSN) and Federal Employer Identification Number (FEIN) - Individuals are required to use a personal SSN as a form of valid Tax ID. Facilities and groups will input a FEIN available to use as a Tax ID.
- Disclosures - Business ownership information is required when completing the Disclosures section of the application. Ownership and Control Interest is submitted for the enrolling entity. If the enrolling entity is an Individual practitioner, Ownership and Control information of the billing provider is not required, so the response to Section A is generally "No".
A Social Security Number (SSN) is required for each owner when disclosing information to individual owners of the business. A secondary question, "Is this entity an individual?" must be answered "Yes" when disclosing information for individual owners of the business. An additional question, "Date of Birth' will be populated and must be answered when disclosing information for individual owners of the business.
If there is no ownership of 5%, the board of directors' information should be entered, including addresses, dates of birth, and social security numbers for each individual listed.