becoming a medicare provider

Application Packet: Contains all provider enrollment application forms. Use the online PECOS system or download here.

CMS 855I form - Medicare enrollment application for physicians and non-physician practitioners:

All doctors of optometry who wish to bill the Medicare contractor for services rendered to Medicare covered individuals need to complete this form. Other instances in which an 855I is required to be submitted are if you are an individual practitioner and: 

• Are currently enrolled with a Medicare fee-for-service contractor but need to enroll in another fee-for-service contractor’s jurisdiction, e.g., you have opened a practice location in a geographic territory serviced by another Medicare fee-for-service contractor. 

• Are currently enrolled in Medicare and need to make changes to your enrollment information, e.g., you have added or changed a practice location.

• Are an individual who has formed a professional corporation of which you are the sole owner. 

Use the online PECOS system or download the form at https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855i.pdf. 

CMS 855R form - Reassignment of Medicare Benefits form. 

This Medicare enrollment application is for individual doctors of optometry who practice in a multi-doctor or group practice to reassign (or terminate) Medicare benefits to that group practice. Services provided can then be billed by, and paid to, the provider or group for which you are working. Likewise, use this form if you wish to terminate a reassignment of benefits. 

Use the online PECOS system or download the form at https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855r.pdf.

CMS 855B form - Clinics/Group Practices and Certain Other Suppliers enrollment form:

Complete this application if you are: a) a multi-doctor group practice that plans to bill Medicare, b) are currently enrolled with a Medicare fee-for-service contractor but need to enroll in another fee-for-service contractor’s jurisdiction, e.g., you have opened a practice location in a geographic territory serviced by another Medicare fee-for-service contractor, or c) you are currently enrolled in Medicare and need to make changes to your enrollment data, e.g., you have added or changed a practice location. 

Use the online PECOS system or download the form at https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855b.pdf. 

CMS 855S form - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier: 

If eyeglasses or other durable medical equipment provided to Medicare beneficiaries, then this form needs to be completed for each optometrist in the practice and submitted to the National Supplier Clearinghouse (NSC). Medicare requires that optometrists be assigned a Durable Medical Equipment Regional Carrier (DMERC) Supplier Number if you will be providing or billing for materials, e.g., frames and lenses. (Note: Eyeglasses are not covered by Medicare except following cataract surgery.) If you have more than one location, you must apply for a supplier number for each location. NSC will process the data and will issue a supplier number before you can submit claims to the DMERC. Contact NSC at (866) 238-9652. 

Use the online PECOS system or download the form at https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855s.pdf. 

CMS 460 form -  Medicare Participating Physician or Supplier Agreement:

Doctors of optometry enrolled with Medicare must decide whether to be a participating or non-participating physician by completing this form. Participating doctors of optometry agree to always accept assignment, i.e., payment directly from Medicare, instead of having the patient pay the allowed charge and then the patient seeks reimbursement from Medicare. Generally, participating ODs receive a 5 percent higher reimbursement than non-participating optometrists. New doctors of optometry can sign the agreement and become a Medicare participating provider at the time of their enrollment with Medicare. Other doctors can enroll during the open enrollment period toward the end of each calendar year — generally from mid-November through December 31. 

Download the form at www.cms.gov/Medicare/ CMS-Forms/CMS-Forms/Downloads/CMS460.pdf. 

CMS 588 form - Electronic Funds Transfer (EFT) Authorization Agreement form:

All doctors of optometry enrolled and reimbursed by Medicare are required to receive their reimbursement by electronic funds transfer (EFT). Doctors of optometry should submit the form at the time of Medicare provider enrollment; change to EFT account information, e.g., account or bank change, change of practice ownership or location or, cancellation of EFT enrollment. 

Download the form at www.cms.gov/Medicare/CMS-Forms/CMSForms/ downloads/CMS588.pdf. 

Application Submittal Addresses:

For Southern California (Counties: Ventura, Los Angeles, Orange, Imperial, San Diego, Santa Barbara and San Luis Obispo): 

Noridian JE Part B — Southern CA Enrollment, PO Box 6775, Fargo, ND 58108-6775

For Northern California (All other counties):

Noridian JE Part B — Northern CA Enrollment, PO Box 6774, Fargo, ND 58108-6774

CAUTION! The Medicare enrollment process is unfriendly to optometrists/physicians. Read through the application instructions thoroughly, carefully review the requirements and assemble all of the required information before submitting a Medicare enrollment form (paper or electronic). If any part of the application is incomplete, supporting documentation is missing or other mistakes are made, the enrollment process can be delayed for months. The Medicare contractor for California, Noridian Healthcare Solutions, processes the enrollment applications, not Medicare headquarters in Baltimore. 

While the majority of Medicare beneficiaries receive their health coverage from original Medicare, more individuals are choosing to get their benefits from a Medicare Advantage plan, also known as a Medicare private health plan. Medicare Advantage plans are approved by Medicare and offered by private insurance companies. Medicare Advantage plans are required to offer coverage that is comparable to original Medicare Parts A and B. 

Getting on a Medicare Advantage panel is a completely different process than applying to be a traditional Medicare provider. To apply to be a Medicare Advantage provider, you must specifically request a Medicare Advantage contract from the private plan offering that coverage. You are not automatically a Medicare Advantage provider if you are already a provider for Medicare or a private health plan that is offering Medicare Advantage. 

COA has prepared a “Medicare Advantage” fact sheet that is located on the COA website (login required) under "Membership 2020," "Knowledge,” "Fact Sheets".