Medicare Identity & Access Requirements for Credentialing Purposes

Effective Oct 7, 2013, Medicare will require physicians whose staff credentials on their behalf to register with NPPES (NPI). Once the staff member is active on PECOS and NPPES (same login), the physician must send an invitation to their staff member to add them as an Authorized Official or Delegated Official. The reasoning behind this change is to ensure physicians, PA/NP’s, therapists, DDS, and all other providers who bill for Medicare patients are involved in the process of credentialing. 

There is no doubt this will cause some headaches and a few disgruntled providers and credentialers. Getting physicians, CVO’s and staff members on board with this process will not be easy and it will take some time to understand that we need to ALL enroll in PECOS/NPPES regardless of our position within the industry. We will also have to associate and unassociate staff members from physicians as people come and go into credentialing positions. 

FAQ’s Medicare published on this issue: https://nppes.cms.hhs.gov/IAWebContent/FAQs.pdf

CMS Identity and Access page: https://nppes.cms.hhs.gov/IAWeb/login.do