Answer_Book / Enrollment_in_Medicare / Modified application available for providers not enrolled in Medicare

Why This Topic Matters

Organizations that bill Medicare need to know when an ordering or referring provider must have enrollment status in place, how to respond when enrollment is limited to ordering/referring purposes, and what related administrative documents may be involved.

Article Sections

1. Modified application available for providers not enrolled in Medicare

   Introduces the Medicare enrollment topic and the circumstance under which an alternate application process may apply. Also notes the general remittance issue associated with an unenrolled ordering or referring provider.

2. There are 7 basic steps to the process

   Summarizes the broad steps in the application workflow, including the form, sections to complete, and signature requirements. Also mentions the need for an accompanying cover letter and related administrative expectations.

3. Note

   Identifies additional Medicare enrollment forms that are not required in this situation.

4. Tip

   Lists general categories of providers who may commonly fall into the ordering-or-referring-only group.

5. Medicare Administrative Contractors (MAC) will send a notification letter

   Describes the type of notification a contractor may send once the provider is recognized for ordering and referring purposes only.