Respond to Development Letters/Requests for Information

MACs review enrollment application to ensure they are complete. If there are any issues with an application, the MAC(s) will reach out to the person who is listed in the contact person section of PECOS or  paper application for more information. An individual practitioner may designate themselves as the contact person or select someone else who has knowledge of the application such as an office staff member. If the contact person section of the application is left blank, the MAC(s) will contact the practitioner directly using the information in Section 2 of the application where the Correspondence Mailing Address is provided. According to CMS, 30 to 35% of applications require at least one round of corrections.

A MAC(s) may reach out to you via email, fax, phone or letter to communicate about an application. You have 30 days to respond to any inquiries, supply additional documentation, and submit corrections. If you fail to respond you may face delays, have your application(s) rejected, or have your effective date deferred.

Note: There are two ways to check the status of your PECOS application. Periodically review your application status to ensure a timely response to any inquiries/development letter issues.

1. Log in to PECOS and click on the “View Enrollments” link. You will find your application in the “Existing Enrollments” section.
2. If you want to view your status without logging in, go to PECOS. Under “Helpful Links” choose click on “Application Status.”

Site Visits

CMS is required to screen all prospective Medicare providers during the initial application process. Depending on a provider’s circumstances, site visits may be a part of provider enrollment process. Site visits are visits to a provider’s practice location(s). Site visits are one way CMS prevents questionable providers from enrolling in, and/or maintaining enrollment in, the Medicare program.

Whether a provider will be subject to a site visit depends on the level of risk assigned to the provider. The risk levels assigned to providers are: Limited, Moderate or High. Site visits must be conducted when providers are screened and determined to be moderate or high-risk.

Psychotherapists are typically categorized as limited-risk providers. As limited-risk providers, psychotherapists will have their licenses verified, undergo federal database checks to ensure provider type requirements have been met, and will be expected to confirm their practice location address(es).

Risks are generally assigned by provider and supplier type and may be elevated to moderate or high-risk for the following reasons:

• The provider or supplier has been excluded from Medicare or other federal health care programs;
• The provider or supplier has been terminated from Medi-Cal or another’s state’s version of Medicaid;
• The provider or supplier applied for Medicare within six months after a temporary moratorium; or
• Within the last 10 years the provider or supplier had Medicare payment suspensions or their Medicare billing privileges were revoked
• Within the last 10 years the provider or supplier had final adverse actions taken against them (Note: See 42 C.F.R. §424.502 for a definition of final adverse action.)

What You Should Know In Case You are Subject to a Site VisitCMS uses a National Site Visit Contractor (NSVC) to conduct site visits for Medicare Part B providers who are categorized as moderate and high-risk. The current NSVC is MSM Security Services, LLC (MSM). MSM, or one of its subcontractors, will conduct a screening and site verification process according to Medicare guidelines. Providers who have a moderate-risk screening level will have their licenses verified, undergo federal database checks and will receive an unannounced site visit.

During an observational visit for moderate-risk providers, the inspector has minimal contact with the provider and is there to observe that the business is in operation at that location. During a detailed review for high-risk providers, the inspector enters the practice location, speaks with staff, takes photographs, and collects information to confirm the provider’s compliance with CMS standards.

As part of screenings of high-risk providers, a set of fingerprints for a national background check is required from all individuals who maintain a 5 percent or greater direct or indirect ownership interest in the provider or supplier.

Inspectors performing site visits will carry a photo ID and a CMS-issued, signed authorization letter the provider or supplier may review. If you or your staff want to verify CMS ordered a site visit, contact your MAC. If you have office staff, make sure your staff is aware of the possibility of a site visit and the general site visit process. If an inspector is unable to conduct a site visit, the practice and/or provider’s enrollment application may be denied.

Application Processing Timeframes

Generally, complete PECOS applications will be processed within 15 calendar days after they are received. Complete paper applications are generally processed within 30 calendar days after they are received. These processing timeframes may be extended if applications are incomplete or site visits are required.

Application Tracking

MACs have application status tracking search functions on their website where you can enter in application/reference number or Web Tracking ID and find out the status of your application.

Application Approval

Approval of an application means the enrolling provider has been determined to be eligible under Medicare rules and regulations to be granted Medicare billing privileges. A provider is not officially approved until the Medicare claims system is updated. This typically happens within 1 to 2 days after a MAC approves an application. Upon approval, the MAC will send a letter through the mail notifying the contact person or provider of the approved status.

Provider Transaction Access Number (PTAN)

A PTAN is a Medicare-only number MACS issue to providers upon enrollment. The Medicare approval letter will include the PTAN that has been assigned to you. A PTAN is used to bill the Medicare program and to authenticate a provider when using the Interactive Voice Response (IVR) phone system, internet portal or on-line application status. The PTAN is typically limited to the provider’s contact with their MAC. If you enroll in multiple states, you will receive separate PTANs.

Non-physician practitioners ( are assigned PTANS based on their private practice and group affiliations (i.e. sole proprietor, reassignment of benefits). Individuals who reassign their benefits receive a member PTAN for each group PTAN they reassign their benefits to. A sole owner would have a group PTAN assigned for the business and a member PTAN assigned for themselves. PTANs are assigned per EIN, per State. An existing provider would require a new PTAN if adding a new location in a different payment locality in the same State or enrolling a different provider type. An exception to this rule would be hospitals that receive a PTAN per department.

Keep Information Current

Providers should report any information changes using PECOS. Non-Physician Practitioners (NPPs), and NPP organizations must report a change of ownership (including a change in authorized or delegated official), a change in practice location, and any final adverse legal actions (like a felony or suspension of a federal or state license) within 30 days of the change and report all other changes within 90 days of the change.

For more information about change of ownership policies and procedures see 42 C.F.R. §489.18. Providers with ownership  questions should email providerownership@cms.hhs.gov.