50-State Healthcare and Pharmaceutical Licensing Compliance Guide
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Medicare Provider License

Learn how to obtain or maintain a Medicare provider license in all 50 states.

A Medicare provider is a physician, health care facility, or agency that accepts Medicare insurance. According to the Centers for Medicare & Medicaid Services, the following individuals and companies may be eligible to receive Medicare provider licensure:

  • You are a health care provider who wants to bill Medicare for your services, and you have the ability to order and certify patient care through Medicare.
  • You do not want to bill Medicare for your services, but you want to enroll solely to order and certify patient care through Medicare.
  • You want to provide services to beneficiaries but do not want to bill Medicare for your services.
  • You want to enroll as a supplier who does not dispense or furnish durable medical equipment, prosthetics, orthotics, and supplies.

Obtaining a Medicare Provider License

Licensing requirements for Medicare provider licenses are managed at state and federal levels. It is essential to verify the process in your state to ensure you are prepared every step of the way. Becoming a Medicare provider requires first completing the following through the CMS:

  • Get an NPI. National Provider Identifier (NPI) numbers are issued through the National Plan & Provider Enumeration System (NPPES). You can apply for an NPI on the NPPES website.
  • Complete the Medicare Enrollment Application. You enroll using the Provider Enrollment, Chain, and Ownership System (PECOS), which is the online Medicare enrollment system. PECOS has video and print tutorials and will walk you through your enrollment to ensure your information is accurate.
  • Work With Your Mac. Your Medicare Administrative Contractor (MAC) is specific to the region where you practice and may have additional requests for information while they process your application. You can also check in with your MAC regarding your enrollment status.

Once you become a Medicare provider, it is crucial to keep your information updated. To avoid having your Medicare billing privileges revoked, be sure to report the following changes within 30 days:

  • A change in ownership
  • An adverse legal action
  • A change in practice location

You must report all other changes within 90 days. If you applied online, you can keep your information up to date in PECOS. If you applied using a paper application, you’ll need to resubmit your form to update information.

Meeting the Medicare provider license requirements is not always an easy process. Fortunately, the Harbor Compliance License Manager helps healthcare professionals maintain their licenses by automating repetitive tasks, such as tracking renewals. Through License Manager, you can also access LicenseIQ™ - our extensive licensing database - to research the requirements in the states where you operate.

Maintenance and Renewal

There are several steps businesses need to take to ensure they continue to comply with state and federal laws. License renewal often happens on an annual or biennial basis. For Medicare providers, this is known as revalidation.

At Harbor Compliance, we offer a range of software and managed services that assist firms with annual licensing and other business lifecycle compliance needs, such as annual reporting and registered agent services. We help clients accurately track due dates and filing requirements so that your business will continue to be compliant with state and local requirements. Plus, you will have the time to continue working and expanding your clientele.

If you are looking for software to manage the task, or to outsource your license maintenance and business compliance duties, Harbor Compliance can help. We are available to review your business status, ensure you are in good standing in the states where you operate, and explain the steps to ensure you remain compliant with state and federal regulations. Contact our licensing specialists today to learn more.

Explore Licensing by State

Click on a link below to view licensing information in your state.

Controlled Substance Registration - In addition to a pharmacy license, controlled substance registration registration is required in many states for pharmacies that distribute controlled substances.

NABP (National Association of Boards of Pharmacy) - Host a variety of programs and resources relating to pharmacist and pharmacy licensure and examination.

Pharmacist in Charge - A licensed pharmacist designated by a pharmacy to act as the party responsible for compliance with regulations.

VPP (Verified Pharmacy Program) - A program run by NABP that allows state boards to share information and more easily register out-of-state pharmacies.

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