Become non participating provider

Participating Provider

To be a participating provider under Medicare, you must be in compliance with the applicable provisions of title VI of the Civil Rights Act of 1964 and must enter into an agreement under §1866 of the Act which provides that you: (1) will not charge any individual or other person for items and services covered by the health insurance program other than allowable charges and deductibles and coinsurance amounts; and (2) will return any money incorrectly collected from the beneficiary or other person on their behalf or make such other disposition that would cause a termination of your agreement.

Toward the end of each calendar year there is an open enrollment period. The open enrollment period generally is from mid-November through December 31. During this period, if you are enrolled in the Medicare Program, you can change your current participation status beginning the next calendar year on January 1. This is the only time you have the opportunity to change your participation status.

New physicians, practitioners, and suppliers can sign the participation agreement and become a Medicare participant at the time of enrollment into the Medicare Program. The participation agreement will become effective on the date of filing; i.e., the date the participant mails (post-mark date) the agreement to the Medicare Administrative Contractor (MAC) or delivers it to the MAC.

PHYSICIAN, PRACTITIONER OR SUPPLIER CURRENTLY ENROLLED: 

If you choose to participate:

Do nothing if you are currently participating, or
If you are not currently a Medicare participant, complete the blank agreement (CMS-460) and mail it (or a copy) to each MAC you submit Part B claims. You may also fax the completed form to (717) 728-8759 (Jurisdiction L).

On the form show the name(s), address(es) and identification number(s) under which you bill. The identification number is your National Provider Identifier (NPI).

If you decide not to participate:
Do nothing if you are currently not participating, or
If you are currently a participant, write to each MAC to which you submit claims, advising of your termination effective the first day of the next calendar year. This written notice must be postmarked prior to the end of the current calendar year.

NEW PHYSICIAN, PRACTITIONER OR SUPPLIER: 

If you choose to participate:
Complete the blank agreement (CMS-460) and submit it with your Medicare enrollment application.
If you have already enrolled in the Medicare program, you have 90 days from when you are enrolled to decide if you want to participate. If you decide to participate within this 90-day timeframe, complete and submit the CMS-460. The participation agreement will become effective on the date of filing; i.e., the date the participant mails (post-mark date) the agreement to the MAC or delivers it to the MAC.

If you decide not to participate:
Do nothing. All new physicians, practitioners, and suppliers that are newly enrolled are automatically non-participating. You are not considered to be participating unless you submit the CMS-460 form.

Under the Medicare law, the following Practitioners are required to accept assignment for all services rendered to Medicare beneficiaries. 

• Physician Assistant
• Nurse Practitioner
• Certified Registered Nurse Anesthetist
• Clinical Nurse Specialist
• Certified Nurse Midwife
• Clinical Social Worker
• Clinical Psychologist

Because assignment must be accepted, the automatic advantages of participation will be received. Therefore, it is not necessary to complete a participating agreement when enrolling in the Medicare program.