Tips

1. Providers must obtain and NPI from the National Plan and Provider Enumeration System (NPPES) before they can apply to become a Medicare provider or update information on their existing Medicare records.  This number is required on all versions of the CMS-855 enrollment forms.
   
   
2. Providers can avoid issues with CMS-855 enrollment form processing by ensuring the data reported on the CMS-855 form matches the information on file with the IRS and the NPPES Registry.  For example, the Legal Business Name as it appears with IRS should be used on the CMS-855 form and also at NPPES.  Any mismatches or inconsistencies with this data will cause delays in processing of CMS-855s and could cause claim rejections.  
   
   
3. There are two types of NPIs, 'Type 1- Individual' and 'Type 2 - Organization'. To understand which one you need for the specific version of the CMS-855 application you are completing, see these two detailed articles on the CMS website
   
   • Medicare Provider Enrollment of Individuals
   • The Who, What, When, Why & How of NPI
     
4. Part A providers should select "Medicare/OSCAR /Certification" as the type of legacy identifier in the 'Other Provider Identifier' field when reporting NPI/Medicare OSCAR relationships on the NPPES Registry.
   
5. Any changes in information should be communicated to NPPES as well as the Medicare contractor.  (There is no automatic update to the Medicare files based on NPPES or vice versa.)  Allow 45 days processing time for changes of information sent to Medicare on a CMS-855 form.  Also, once information on the NPI has been reported via a CMS-855 form, subsequent updates to the NPPES Registry will not change Crosswalk data.  That must be done through the CMS-855 application.
   
   
6. Once providers/suppliers have reported their NPI(s) to Medicare via the CMS-855 process, "linkages" are created in our claims processing system between the NPI(s) provided on the CMS-855 and 1) any newly assigned identifier(s) (PIN/PTAN), or 2) legacy identifier(s) (PIN/PTAN).  It is crucial that once these linkages are established, the same NPI-PIN/PTAN relationships are consistently reported on future CMS-855 applications.  If the same relationships are not consistently reported, any established linkages could be altered (changed/removed), which could cause serious impacts to claims processing.