As we noted in articles in the December 2015 and March 2016 issues of Network Matters, the Centers for Medicare and Medicaid Services (CMS) has published a new rule that will require nearly all commercial and Medicare Advantage providers who prescribe drugs for Medicare patients to enroll as a participating Medicare provider—or validly opt out—as soon as possible.
Effective February 1, 2017, Medicare Part D prescription drug benefit plans will not cover drugs prescribed by providers who have not taken the proper steps to enroll or opt out of participating in Medicare. Please note that if you opt out of participating in Medicare, you will not be able to receive reimbursement from original Medicare or Medicare Advantage Plans, including Harvard Pilgrim’s StrideSM (HMO) Medicare Advantage plans.
Provider enrollment process
You can enroll as a participating Medicare provider for free, electronically or on paper, either fully or for the limited purpose of prescribing Part D drugs. Harvard Pilgrim encourages electronic enrollment for timeliness and efficiency.
To enroll as a participating Medicare provider electronically, use the PECOS system at go.cms.gov/pecos. For limited enrollment, refer to these step-by-step instructions on the CMS website, or watch this video tutorial. To enroll on paper, complete the paper application for limited enrollment at go.cms.gov/cms855o and submit it to the Medicare Administrative Contractor (MAC) in your geographic area, which can be found on the MAC list at: go.cms.gov/partdmaclist.
If you are not currently enrolled as a participating Harvard Pilgrim StrideSM (HMO) Medicare Advantage provider, contact the Medicare Advantage Provider Service Center at 888-609-0692 or your contract manager.