Common Reasons Enrollment Applications Are Returned to Providers

Did you know that half of all enrollment applications are returned to providers for the following errors? Providers are encouraged to review the information below for faster approval.

  1. Incorrect Taxonomy Code - The NPI and taxonomy code submitted with the provider’s enrollment application must match the information on record with the National Plan and Provider Enumeration System (NPPES).
  2. Missing or Non-Matching Attachment Information - Information on the document(s) provided as proof of licensure, certifications, insurance, or any additional required documentation must match the information provided on the application.
    • Licenses and Certifications - Effective dates or end dates provided on the application must match the documents provided as proof of licensure/certification.
    • Professional Liability Insurance - Coverage dates provided on the application must match the documents provided as proof of insurance. *Malpractice/Liability insurance information must be entered in the application by all providers.  However, proof of insurance is a required attachment for Nursing Facilities and HCBS providers only.)
    • Electronic Funds Transfer (EFT)
      • Bank letters attached must include:
        • A current date (within six months of the enrollment application date)
        • Business name and address
        • Information on the account type, routing number, and account number
        • Signature from an authorized bank representative from the attached bank’s company
      • Voided checks attached must include:
        • The business name and address
        • Routing and account numbers
      • W-9 - The Organization in the application needs to match the Tax Classification on the W-9.  The W-9 must also be dated within six months of the enrollment application date.
    Legal entity information on the application must match the documents provided as proof of legal entity status.
  3. Tax Identification Numbers: Social Security Number (SSN) and Federal Employer Identification Number (FEIN) - Individuals are required to use a personal SSN as a form of valid Tax ID. Facilities and groups will input a FEIN available to use as a Tax ID.
  4. Disclosures - Business ownership information is required when completing the Disclosures section of the application. Ownership and Control Interest is submitted for the enrolling entity.  If the enrolling entity is an Individual practitioner, Ownership and Control information of the billing provider is not required, so the response to Section A is generally "No".

    An SSN is required for each owner when disclosing information for individual owners of the business. A secondary question, ‘Is this entity an individual?’, must be answered ‘Yes’ when disclosing information for individual owners of the business. An additional question, ‘Date of Birth’ will be populated and must be answered when disclosing information for individual owners of the business.

    If there is no ownership of 5%, the board of directors’ information should be entered, including addresses, dates of birth, and social security numbers for each individual listed.