Skip to Content

CMS Announces New Medicare Enrollment Form for Physician and Non-Physician Practitioners


The Centers for Medicare & Medicaid Services (CMS) has developed and received approval for a new Medicare Enrollment Application.

The new form applies to both physicians and non-physician practitioners who use paper applications to Medicare. If providers are completing the enrollment forms online via PECOS, the most up-to-date application is already available.

New Enrollment Form Changes Reduce Provider Burden

  • Although many changes to the enrollment form are minor, the more major modifications are welcome and will reduce the burden on providers. These include:

  • Expanded instructions for individual and group affiliations that will help to simplify reporting.

  • Eliminating the reporting requirements for advanced diagnostic imaging, Clinical Laboratory Improvement Amendments number, and the FDA radiology certification number.

  • Making it optional to include a contact person.

  • Creating a more logical data flow.

  • Adding electronic storage information if paper records are no longer kept.

The new application is available for immediate use. Note that Medicare Administrative Contractors will continue to accept the 7/2011 application form through April 30, 2019. After that date, however, the new form must be used.

Another important note: If you are using paper applications, always pull the form from CMS so you don’t accidentally use an older version.

You can read more in this mlnconnects update.

Let Us Manage All Your Payer Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.

Complimentary Consultation Available

Categories: 1ˢᵗ Credentialing, Credentialing Requirement, Medicare and Medicaid

Tags: , , ,

Free Consultation

Schedule your free consultation

Our credentialing experts are here to help you assess exactly which solutions you need to put you on the right track. 1ˢᵗ Credentialing includes payor enrollment for all insurance networks. Don’t wait another minute, contact our team today!

Call us at (512) 201-2668 or email us at

Back to top