Keeping You Connected

The SFMMS keeps you up to date on the latest news,
policy developments, and events

San Francisco Marin Medical Society Blog

Changes to Enrollment Requirements for Medicare Part D Prescribers

Beginning on June 1, 2016, all physicians and other providers who prescribe Medicare Part D drugs must be enrolled in Medicare or have a valid record of opting out. Failure to do so will result in a denial of the pharmacy claim or the beneficiary’s request for reimbursement.

All physicians and other prescribers who are not currently in compliance are encouraged to complete their Medicare enrollment or submit an opt-out affidavit no later than January 1, 2016. This will ensure sufficient processing time so that their Part D patients will continue to have access to necessary medication without interruption.

If you are unsure if you are compliant with this requirement, please review the CMS prescriber enrollment file.

Enrollment applications can be submitted on paper or online via PECOS. To enroll offline using a paper enrollment form, complete the CMS-855O application and mail to Noridian. Providers should be aware, however, that this form only allows you to enroll in Medicare for the purpose of ordering and certifying services and items, and to prescribe Part D drugs. It will not allow you to bill or be paid for Medicare services. To apply as a Medicare provider with full billing privileges, you will need to complete the appropriate form(s) CMS-855.

For more information, see the CMS Part D Prescriber Enrollment webpage and MLN Matters number SE1434. CMS has also put together a Part D Provider Enrollment FAQ.

For more information on opting out, see the Noridian website.

Comments are closed.