The Certified Provider Enrollment Process Loop

Published 10/29/2020

Palmetto GBA strives to provide excellent customer service and would like to provide insight into the Certified Provider Enrollment Process. The process detailed below applies to all Part A certified provider types enrolling using the Centers for Medicare & Medicaid Services (CMS) Form 855A, and Part B Portable X-Ray and Ambulatory Surgery Center (ASC) providers enrolling with CMS Form 855B.

The certified enrollment process has three (3) separate and distinct steps.

Step 1 — Submit Application to the Medicare Administrative Contractor (MAC)
Submit your completed CMS Form 855A to Palmetto GBA for review and processing. Upon receipt you will be notified that we have your application and provided with a Document Control Number (DCN) for monitoring the progress of the application using our website or Interactive Voice Response (IVR) system.

A complete review of your application will be completed and there are deficiencies or missing supporting documentation a development letter will be issued to the contact person identified on the application. Requested information should be provided back to Palmetto GBA within 30 to prevent the application from being rejected for non-response.

Once application processing is completed, we will issue a recommendation for approval letter to your local State Agency (SA) and the appropriate CMS Regional Office (RO).

Step 2 — State Agency Processing

  • What does the state and regional office do with your application?
  • Please check your state (PDF, 545 KB) for information regarding the enrollment process

The state will:

  • Conduct a survey of the site
  • Validate your accreditation

Once the state completes its review process, a completed packet will be sent to the Regional Office (RO) for review and final approval.

Step 3 — CMS Regional Office Issues Approval
The Regional Office (PDF, 48 KB) verifies with the state that there are no deficiencies and evaluates eligibility to participate in the Medicare Program. If approval is granted, the RO will issue a Tie-In to Palmetto GBA and simultaneous notification to the provider. Please note that you must await formal notification from Palmetto GBA before you can submit claims. An approval letter will be issued by Palmetto GBA letting you know the enrollment process is complete, at which time you may proceed with enrolling in EDI (Electronic Data Interchange) to submit your claims electronically.

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