Medicare, Medicaid, and commercial payer enrollment — all at once

Submit ALL applications the same week

Each payer processes independently. Timeline: 60–120 days per payer. Starting them together is the only way to minimize the gap before revenue begins.

Confirm Medicare eligibility

You must hold an active state NP license, your national certification, and a DEA registration before applying.

Create a CMS I&A account at pecos.cms.hhs.gov

Log into PECOS 2.0 and start a new enrollment

Select CMS-855I — Individual Enrollment Application

Complete all sections and upload documents

License, DEA, NPI, EIN, malpractice policy, and CV.

Pay the $750 enrollment fee

Submit electronic signature

Receive your PTAN + billing effective date

Your PTAN is your Medicare provider number. Billing can begin on the effective date shown in your approval letter.

Set up EFT and ERA with your MAC

Your Medicare Administrative Contractor handles payment routing and electronic remittance.

Find your state Medicaid provider portal

Search ‘[State] Medicaid provider enrollment.’ Each state has a different portal.

Identify all Medicaid MCOs in your state

Most Medicaid patients are in managed care organizations — you need to credential with each MCO separately.

Authorize each MCO in your CAQH profile

Log into proview.caqh.org → Plan Authorization → add each MCO.

Submit MCO enrollment applications

Each MCO has its own form and timeline. Complete background check if required. Keep a spreadsheet of every provider number.

Call each payer — are you accepting new NP providers?

Don’t skip this call. Some payers have provider freezes by specialty or geography.

Request the NP/APRN credentialing application

Behavioral health may have a separate application from primary care.

Authorize each payer in CAQH + submit application

Submit with W-9, malpractice, licenses, DEA. Keep copies of everything. Record every reference number.

Follow up every 14 days by phone

Credentialing departments are understaffed. Polite, persistent follow-up is standard practice.

Receive approval + effective date + provider number

Do not see patients under this plan until you have an effective date in writing. Set up EFT/ERA and run a test claim first.