The Provider Enrollment Gateway can be used as a secure mechanism for providers and suppliers:
Uploading paper enrollment applications.
Submitting responses to development requests for a paper application submitted through the gateway.
Requesting a copy of enrollment correspondence for a paper application submitted through the gateway.
To check the status of a previously uploaded paper application submitted through the gateway.
It also provides an alternative for providers and suppliers unable to utilize the PECOS or those that have automated processes for pre-populating paper enrollment applications from their credentialing databases.
The gateway accepts only the following paper enrollment application types in portable document format (PDF):
Medicare Enrollment Application - Institutional Providers (
CMS 855A)
Medicare Enrollment Application - Clinics/Group Practices and Other Suppliers ()
CMS 855B)
Medicare Enrollment Application - Physicians and Non-Physician Practitioners (
CMS 855I) Medicare Enrollment Application - Ordering and Certifying Physicians and Other Eligible Professionals (
CMS 855O) Medicare Enrollment Application - Medicare Diabetes Prevention Program (MDPP) Suppliers (
CMS-20134) Medicare Enrollment Application - Medicare Participation Agreement (
CMS-460)Please note that at this time, the gateway will only accept the application types listed above.
The gateway will reject the following stand-alone submissions that are not submitted as part of the PDF enrollment application package, which include but are not limited to:
Electronic data interchange applications,
Opt-out affidavits.
Appeals (corrective action plans (CAPs), reconsiderations, or rebuttals).
Miscellaneous correspondence.
Please continue to send stand-alone non-enrollment applications via mail, fax, or email, as applicable.
In order to submit your application(s) successfully, please ensure that you have gathered all necessary documents required to enroll for your provider or supplier type.
1. Download the appropriate application(s).
2. Complete the application(s) electronically and save the application(s) on your computer.
3. Upload or scan any necessary supporting documentation. Supporting documentation includes:
Licenses, certifications and registrations required by Medicare or state law.
Federal, state, and/or local (city/county) business licenses, certifications and/or registrations required to operate a health care facility.
Written confirmation from the IRS confirming your Tax Identification Number with the legal business name (e.g., IRS CP 575) provided in section 2.
Copy of IRS determination letter, if supplier is registered with the IRS as non-profit.
Written confirmation from the IRS confirming your limited liability company is automatically classified as a disregarded entity. (e.g., Form 8832).
A disregarded entity is an eligible entity that is treated as an entity not separate from its single owner for income tax purposes.
Copy of all bills of sale or sales agreements (change of ownership (CHOW), acquisition/mergers, and consolidations only).
Copy of all documents that demonstrate meeting capitalization requirements (home health agencies only).
Copy of all documentation verifying the state licenses or certifications of the laboratory director or non-physician practitioner personnel of an independent clinical laboratory.
Statement in writing from the bank. If Medicare payment due a provider of services is being sent to a bank (or similar financial institution) with whom the provider has a lending relationship (that is, any type of loan), then the provider must provide a statement in writing from the bank (which must be in the loan agreement) that the bank has agreed to waive its right of offset for Medicare receivables.
Copy(s) of all adverse legal action documentation (e.g., notifications, resolutions, and reinstatement letters).
Copy of health resources and services administration notice of grant award if that is a qualifying document for federally qualified health center status.
Completed Medicare Participation Agreement (CMS-460).
The Medicare Participation Agreement (CMS-460) must be submitted for all initial enrollments or reactivations only if you want to be a participating practitioner in Medicare.
Copy of an attestation for government entities and tribal organizations.
Copy of FAA 135 certificate (air ambulance suppliers).
Copy(s) of comprehensive liability insurance policy (independent diagnostic testing facilities (IDTFs) only).
Copy of all documentation verifying IDTF supervisory physician(s) proficiency and/or state licenses or certification for IDTF non-physician personnel.
Copy of the CMS-1561 health insurance benefit agreement (opioid treatment programs (OTPs) only).
Copy of the opioid treatment program’s operating certificate (OTPs only).
4. Save the application(s) and supporting documentation as a PDF file to upload. Please note that the gateway will only accept files that are in a PDF format for initial submission.
5. Have your NPI and an email account accessible since you will be receiving a one-time access code to enter the gateway.
The Provider Enrollment Gateway can be accessed one of two ways:
1. Gateway link (
JH) (
JL)
2.
Novitas website, select jurisdiction H (JH) or jurisdiction L (JL), then select “Provider Enrollment” from the left navigation, and click Enrollment Gateway.
The gateway home screen will look like this:
You must accept the disclaimer in order to access the gateway.
Once you have accepted the disclaimer, you will reach the entry page for the gateway. Please have your NPI and an email account accessible as you will be required to enter them in order to access the gateway.
The entry page will look like this:
Enter your NPI, select the state in which you are enrolling from the drop-down menu, enter your email address, and select an option. The options include:
Submit an application.
Check application status*.
Submit development response*.
*
Note: These two actions are only for paper applications that were submitted through the gateway. To check the status of a paper application that was submitted either via mail or PECOS, please visit
Check your application status, and have your NPI, PTAN, or document control number (DCN) number. You can also check your application status by visiting the
Novitas website, select “Provider Enrollment” from the left navigation, and click “status of my enrollment” from the pop-up menu.
Once you have made your selection, you will receive a one-time six-digit access code to the email address that you entered. Please note that this code is only to be used for this transaction and is only available for 30 minutes. Once it has been used, it cannot be used again. The email subject line will be: Urgent: Provider Enrollment Gateway access. The email will include the six-digit access code, which you will enter in the newly populated one-time access code field. Click the “continue” button.
Example JH:
Example JL:
The NPI that you choose to log in will be required each time you want to check on that submission, submit returned development, or review a letter. The NPI that you entered for the initial submission of the application(s) is tied to the submission identification (ID).
Example:
You are submitting a Clinics/Group Practices and Other Suppliers (CMS-855B) application for a group, and four Physicians and Non-Physician Practitioners (CMS-855I) applications for different re-assigners. You may log into the gateway only one time to upload all 5 applications under one submission using one designated NPI.
If you enter the NPI incorrectly the first time, you may not be able to access any information for that application submission, so it is important that the NPI entered for the initial submission is correct. You will not be able to check the status of another NPI’s application submission since the NPI is linked to the unique submission ID and DCN.
Examples:
An application was submitted for a provider using NPI 1234567890 and submission ID 1564 was assigned. You want to check on an application that was submitted for NPI 1569845651 with submission ID 1779. You will not be able to log into the gateway using NPI 1234567890 and the submission ID for NPI 1569845651 to check on the application status for NPI 1569845651.
You will receive the following error:
A Clinics/Group Practices and Other Suppliers (CMS-855B) and four Physicians and Non-Physician Practitioners (CMS-855I) applications were submitted using NPI 1659845100 and given submission ID 1222. You later tried to check the status of the applications with one of the individual NPIs and submission ID 1779, the status will not be able to be shown since the NPI and submission ID do not match. The same error message above will be provided.
Once you have obtained entry into the gateway, you will need to select the application type, reason, state and Indian Health Services (IHS) (JH only if applicable) for the submission from the drop-down menus.
Application types and reasons:
Ordering/Certifying Physicians and Other Eligible Professionals (CMS-855O)
New enrollee - You are an individual wanting to enroll in Medicare to order and certify services.
Change of information - You are an individual wanting to change information on your Medicare enrollment to order and certify services.
Voluntary termination - You are an individual wanting to voluntarily terminate your Medicare enrollment to order and certify services.
Physicians and Non-Physician Practitioners (CMS-855I)
New enrollee - You are an individual, sole proprietor, or sole owner wanting to enroll in Medicare for the first time.
Enrolling w/new Medicare administrative contractor - You are an individual, sole proprietor, or sole owner enrolled with a Medicare contractor and are now requesting to enroll in another Medicare contractor’s state/jurisdiction.
Revalidation - You are an individual or sole proprietor revalidating your current Medicare enrollment in response to a revalidation request.
Reactivation - You are an individual, sole proprietor, or sole owner wanting to reactivate your Medicare billing privileges.
Change of information - You are an individual, sole proprietor, or sole owner wanting to make changes to your existing Medicare enrollment. This includes applications from either an individual or group establishing or terminating a reassignment.
Voluntary termination - You are an individual, sole proprietor, or sole owner wanting to voluntarily terminate your Medicare enrollment.
Clinics/Group Practices and Other Suppliers (CMS-855B)
New enrollee - You are a Part B group or organization wanting to enroll in Medicare for the first time.
Enrolling w/new fee for service (FFS) - You are a Part B group or organization enrolled with a Medicare contractor and is now requesting to enroll in another Medicare contractor’s state/jurisdiction.
Reactivation - You are a Part B group or organization wanting to reactivate your Medicare billing privileges.
Change of information - You are a Part B group or organization wanting to make changes to your existing Medicare enrollment.
Voluntary termination - You are a Part B group or organization wanting to voluntarily terminate your Medicare enrollment.
Revalidation - You are a Part B group or organization revalidating your current Medicare enrollment in response to a revalidation request.
Institutional Providers (CMS-855A)
New enrollee - You are a Part A organization wanting to enroll in Medicare for the first time.
Enrolling w/new FFS - You are a Part A organization enrolled with a Medicare contractor and is now requesting to enroll in another Medicare contractor’s state/jurisdiction.
Reactivation - You are a Part A organization wanting to reactivate your Medicare billing privileges.
Voluntary termination - You are a Part A organization wanting to voluntarily terminate your Medicare enrollment.
CHOW seller - You are a Part A organization undergoing a CHOW, and you are the seller/former owner.
CHOW buyer - You are a Part A organization undergoing a CHOW, and you are the buyer/new owner.
Acquisition merger/seller - You are a Part A organization undergoing an acquisition or merger, and you are the seller/former owner.
Acquisition merger/buyer - You are a Part A organization undergoing an acquisition or merger, and you are the buyer/new owner.
Consolidation former org - You are a Part A organization that has consolidated with another organization, and you are the former organization.
Consolidation new org - You are a Part A organization that has consolidated with another organization, and you are the new organization.
Change of information - You are a Part A organization wanting to make changes to your existing Medicare enrollment.
Revalidation - You are a Part A organization revalidating your current Medicare enrollment in response to a revalidation request.
Medicare Diabetes Prevention Program (MDPP) Suppliers (CMS-20134)
New enrollee - You are a Medicare diabetes prevention program (MDPP) supplier wanting to enroll to in Medicare for the first time.
Reactivation - You are a MDPP supplier wanting to reactivate your Medicare billing privileges.
Voluntary termination - You are a MDPP supplier wanting to voluntarily terminate your Medicare enrollment.
Change of information - You are an MDPP supplier wanting to make changes to your existing Medicare enrollment.
Revalidation - You are an MDPP supplier revalidating your current Medicare enrollment in response to a revalidation request.
Medicare Participation Agreement (CMS-460)
N/A
State – Select the appropriate state for which the application is being submitted.
IHS (JH only) - Select the IHS indicator if the application is being submitted for IHS and select the state as Texas if IHS.
Once you have selected your application type, reason, state, IHS (JH only if applicable), click the “browse” button to find the application that you have completed and saved on your computer.
It is recommended to save the document as a notable name, like “John Smith CMS-855I application” as the gateway will not accept files that are not in a PDF format, or a non-CMS application type for initial enrollments.
Click the “upload” button once the appropriate document has been selected.
JH:
JL:
Special note for revalidations: You must have your revalidation DCN available in order to upload an application in response to a revalidation request. Once you have chosen the reason of revalidation, an additional box will populate to request the revalidation DCN that has already been created for you.
JH:
JL:
Correct revalidation DCN:
JH:
JL:
Incorrect revalidation DCN:
JH:
JL:
The gateway will display each document uploaded for the submission:
JH:
JL:
If there are supporting documents (i.e., licensure, certification, IRS document, etc.) that need to be uploaded with the application type, select "Yes" to the question "Do you want to Upload Supporting Documents".
Click the "browse" button to find the supporting document that you have saved on your computer. It is recommended to save the document as a notable name, like "Licensure for John Smith" as the gateway will not accept files that are not in a PDF format.
Click the "upload" button once the appropriate supporting document has been selected.
If no supporting documents are needed to be uploaded with the application type, select "No" and proceed with adding any other application types/supporting documents with the submission.
JH:
JL:
The gateway will display each application type and supporting document uploaded for the submission:
JH:
JL:
You will be able to delete the documents prior to submission only. Once you have selected the “submit” button and the applications and documents have been submitted, the applications or supporting documents cannot be rescinded.
When the application(s) and supporting document(s) have been submitted, you will receive a submission ID. The submission ID will display on the confirmation page of the gateway. You will also receive an email confirming the submission ID and the NPI used for the application submission.
Important: You must retain your submission ID and NPI to check the status or submit additional documentation for the application. You will receive a separate submission ID for each application submission.
Please allow a few days for us to receive your application and assign it to a provider enrollment representative for processing. You will receive a DCN for each separate application immediately after the application(s) have been submitted. The DCN can be obtained by checking your application status.
You can check the status of an application one of two ways:
1. Immediately after submitting an application to obtain the DCN.
2. Logging into the gateway after an application has already been submitted.
Checking the application status immediately after submitting an application to obtain the DCN
1. To obtain the DCN immediately after submitting an application, click on the “check status” button:
2. Enter the submission ID that you were just assigned, and select the “submit” button:
3. You will receive information regarding the DCN, including the submitted application type, reason for application, DCN, and status of the application:
Note: The application status is subject to change based on the processing of your application.
4. While checking on the status, you will be able to either submit another paper application or submit a development response. Please note that you are submitting a paper application or development response for the NPI that you chose to use when initially signing in. If you are enrolling multiple providers, you may choose to log into the gateway using each individual NPI, but it is not required.
Checking the application status by logging into the gateway after an application has already been submitted
1. Log into the gateway using the same NPI that you used to submit the application and select “check application status”. Please note that the email address you choose to use is not required to be the same for all actions. You will receive another one-time code to the email address entered and enter it in the one-time access code field.
2. Enter the submission ID that you were assigned, and select submit:
3. You will receive information regarding the DCN, including the submitted application type, reason for application, DCN, and status of the application:
Note: You will not receive a notification email when the status of your application changes since the gateway does not store your email address.
Important: You can only submit a development response for an application that was submitted through the gateway. You may not submit a development response for an application that was submitted outside the gateway, i.e. PECOS web, mail, etc.
1. Log into the gateway using the same NPI that you used to submit the application and select “Submit development response”. Please note that the email address you choose to use is not required to be the same for all actions. You will receive another one-time code to the email address entered and enter it in the one-time access code field.
2. Enter the DCN that you have been assigned; please refer to the DCN indicated on the development letter that you received. The gateway will confirm the DCN and NPI combination after the DCN has been entered:
If the DCN and NPI combination do not match, you will receive this error:
If the DCN that you entered was assigned for an application that was not submitted through the gateway, you will receive this error:
3. Find the application or documentation you wish to submit saved on your computer by clicking the “browse” button. Once you have selected your document, click the “upload” button. You will be able to delete the documents prior to submission only using the “delete” button.
4. Once you have selected the “submit development response” button and the applications and documents have been submitted, the documents or applications cannot be rescinded.
The gateway application will make certain decision letters available after they have been issued. As we continue to develop the program, functionality of the gateway, more decision letters will be available for review via the gateway.
1. Log into the gateway using the same NPI that you used to submit the application and select “check application status”. Please note that the email address you choose to use is not required to be the same for all actions. You will receive another one-time code to the email address entered and enter it in the one-time access code field.
2. Enter the submission ID that you were assigned, and select submit:
3. You will receive information regarding the DCN, including the submitted application type, reason for application, DCN, status of the application, and the action column will display a new “view” button.
4. Click the “view” button and scroll down below the table.
5. Click on the PDF icon in the action column, and the letter will be displayed in a new browser tab, where you will be able to view, save, or print the decision letter.
Note: You will not receive a notification email when a decision letter has been issued through the gateway since the gateway does not store your email address.
The gateway does not store your information, so you may simply close your browser and your current gateway session will be complete. If you wish to start your gateway session over to perform another action or resubmit an application for a different provider or supplier, you may select the home link to be directed back to the main page with the disclaimer. You will be asked to confirm that you would like to start over.
1. How do I check the status of my application that has already been submitted?
You may log into the gateway using your NPI and submission ID and select check status.
2. Who do I contact if I have questions?
You may reach out to our provider enrollment customer service for your designated area via phone; please refer to resources and contacts. If you have a received a decision letter, you may also reach out to the analyst via the phone number specified on your letter.
3. Will submitting an application through the gateway speed up my processing time?
The gateway was designed to increase efficiency with entering a paper application in our processing system by avoiding processing times with the U.S. postal service. Novitas strives to screen, validate, and process our applications with the CMS designated timeframes.
4. What are the advantages for submitting paper applications through the gateway?
The gateway was designed to increase efficiency with entering a paper application in our processing system by avoiding processing times with the U.S. postal service. The gateway is a free service available for our providers and suppliers.
5. How do I know if I’m up for revalidation?
Navigate to the
CMS Medicare Revalidation List and enter your organization name, first name, last name or NPI. Your information will be displayed by name, due date, state, specialty, and NPI. You may have also received a letter requesting you to revalidate up to three months prior to your revalidation due date. The DCN assigned to you to revalidate will be referenced on that letter and required to upload your revalidation application. If you do not have a copy of the revalidation request letter but your revalidation is due, you may reach out to our provider enrollment customer service line to request the DCN.
6. How do I know what CMS form is appropriate for my submission?
Please refer to the application types and reasons above. There are additional FAQs on our tutorials & help page (
JH)(
JL).
7. How do I submit documentation that is not a CMS form accepted by the gateway?
You may submit additional documentation or forms (i.e. appeal or letterhead request) via mail to:
JH regular mail:
Novitas Solutions, Inc.
Provider Enrollment Services
P.O. Box 3095
Mechanicsburg, PA 17055-1813
JH IHS regular mail:
Novitas Solutions, Inc.
Provider Enrollment Services
P.O. Box 3115
Mechanicsburg, PA 17055-1858
JH Appeals (CAPs, reconsiderations, rebuttals)
Novitas Solutions, Inc.
Provider Enrollment Services
P.O. Box 3096
Mechanicsburg, PA 17055-1814
JL regular mail:
Novitas Solutions, Inc.
Provider Enrollment Services
P.O. Box 3157
Mechanicsburg, PA 17055-1836
JL Appeals (CAPs, reconsiderations, rebuttals)
Novitas Solutions, Inc.
Provider Enrollment Services
P.O. Box 3326
Mechanicsburg, PA 17055-1839
Overnight mail:
Novitas Solutions, Inc.
Provider Enrollment Services
2020 Technology Parkway, Suite 100
Mechanicsburg PA 17050
Or fax to:
1-877-439-5479
8. Can I use the gateway with multiple different email addresses?
Yes, the email address provided to the gateway is simply to provide you with the one-time access code to enter the gateway. The email address is not tied to your NPI, submission ID, or DCN.
If you have questions about…. |
Website or phone number |
Novitas Solution’s website |
Website: www.novitas-solutions.com |
Provider enrollment applications, requests, or general provider enrollment information |
JL - (PA, NJ, MD, DCMA, DE): 877-235-8073 JH - (AR, CO, LA, MS, NM, OK, TX): 855-252-8782 Option 4: Provider Enrollment Services |
Provider customer service department |
JL - (PA, NJ, MD, DCMA, DE): 877-235-8073 JH - (AR, CO, LA, MS, NM, OK, TX): 855-252-8782 Options 1, 2, 3, or 5 |
Provider Enrollment Gateway |
Jurisdiction H
Jurisdiction L |
National plan and provider enumeration system |
Website: https://nppes.cms.hhs.gov Phone: 800-465-3203 TTY: 800-692-2326 |
Revalidations |
Website |
Medicare revalidation lookup tool |
Website |
Revalidate your enrollment information |
Website |
Medicare application fee |
Website |
Medicare program integrity manual chapter 10 |
Website |
Medicare provider-supplier enrollment |
Website |
Office of inspector general |
Website |