Processing time frames for enrollment applications
Wednesday, August 19, 2020
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Posted by: Diane Berg
Modified: 8/18/2020 https://medicare.fcso.com/PE_Resources/210279.asp As the Medicare administrative contractor (MAC) for jurisdiction N (JN), First Coast Service Options Inc. (First Coast) is not only responsible for processing Medicare claims but also for processing enrollment applications for providers and suppliers located in Florida, Puerto Rico, and the U.S. Virgin Islands. The Centers for Medicare & Medicaid Services (CMS) has established the following timeliness standards for contractors responsible for processing enrollment applications within their assigned jurisdictions: • PECOS web applications (initial enrollment with no site visit) -- 80% must be processed within 45 days • Paper-based applications (initial enrollment with no site visit) -- 80% must be processed within 60 days • Paper-based applications (initial enrollment with site visit) -- 80% must be processed within 80 days • Paper-based applications (changes to enrollment record or reassignment) -- 80% must be processed within 60 days | | | First Coast Provider Enrollment Average Processing Times
(May 1, 2020 through July 31, 2020)
Timeframes include Initials, Changes and Revalidations |
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| | Part A | Part B | PECOS Web Applications | | | No development | 4 days | 7 days | With development | 12 days | 43 days | Paper Applications | | | No development | 4 days | 9 days | With development | 19 days | 48 days |
Although First Coast processes each enrollment application as quickly as possible, the following key factors may affect the total processing time needed: • Provider type: • Part A -- institutional providers • Part B -- physicians, non-physician practitioners, clinics, and group practices Shortest processing times: Enrollment applications for Part B providers and suppliers • Application type: • Paper-based application -- a paper enrollment application that is printed and submitted through the mail. Shortest processing times: PECOS web applications • Development required: • No development -- the enrollment application (paper-based or electronic) is accurate, complete, and is submitted with all required support documentation. • With development -- the enrollment application (paper-based or electronic) falls into one or more of the following categories: • Contains errors or inconsistencies • Incomplete (e.g., missing information or signature) • Support documentation missing or insufficient Shortest processing times: Enrollment applications that do not require development
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