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Part A Provider Enrollment > Provider Enrollment Definitions
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Part A Enrollment Definitions

  
CMS Definitions Applicable to Provider Enrollment

Applicant - The individual provider/supplier applying for the provider number or PIN change of information.

Authorized Official - An appointed official to whom the provider/supplier has granted the legal authority to enroll it in the Medicare program, to make changes and/or updates to its status in the Medicare program (e.g., new practice locations, change of address) and to commit the provider/supplier to fully abide by the laws, regulations, and program instructions of Medicare. The authorized official must be the provider's/supplier's general partner, chairman of the board, president, chief financial officer, or chief executive officer, or must hold a position of similar status and authority within the provider/supplier. An authorized official can also be anyone who is a direct owner of 5 percent or more of the provider/supplier. An entity can have only one designated authorized official at one time.

Billing Agency - a company contracted by the applicant to furnish all claims processing functions for the applicant's practice.

Carrier- The Part B Medicare Contractor.

Delegated Official - An individual who has been delegated the legal authority by the authorized official of that provider/supplier to make changes and or updates to the organization's status in the Medicare program (e.g., new practice locations, change of address) and to commit the provider/supplier to fully abide by the laws, regulations, and program instructions of Medicare. There is a maximum of three delegated officials at one time.

Fiscal Intermediary - The Part A Medicare Contractor

Group - Two or more physicians, non-physician practitioners, or providers/suppliers who form a practice together and bill Medicare as a single unit.

Legal Business Name - The name that is reported to the Internal Revenue Service.

Management Service Organization - A company contracted by the applicant to furnish some or all administrative, clerical and claims processing function of the applicant's practice.

Medicare Identification Number - This is a generic term for any number that uniquely identifies the enrolling individual or organization as a Medicare Provider/Supplier. Examples of a Medicare Identification Number are: UPINs, PINs, and NSC (National Supplier Clearinghouse) numbers.

PIN - Provider Identification Number - this number is assigned to provider/suppliers in Medicare Part B for the Practice location(s) where they provide services to beneficiaries. This number will identify who provided the service to the beneficiary on Medicare claims. A PROVIDER/SUPPLIER WILL NEED TO APPLY FOR A PIN AT EVERY LOCATION AND MAY RECEIVE SEVERAL THROUGHOUT THEIR CAREER.

Provider - A hospital, critical access hospital, a skilled nursing facility, a comprehensive outpatient rehab facility, a home health agency, or a hospice that is seeking to have in effect an agreement to participate in Medicare; or a clinic, a rehab agency or a public health agency that is seeking in effect a similar agreement: but only to furnish outpatient physical therapy or speech pathology services, or a community mental health center that is seeking in effect a similar agreement but only to furnish partial hospitalization services.

Sole Proprietor - An individual, who is registered as a business, (has a tax identification number from the IRS) and rendering services under the business name.

Supplier - A physician or other practitioner, or an entity other than a provider, that furnishes health care services under Medicare.

Tax Identification number - The number that the individual or organization uses to report tax information to the IRS, such as a Social Security Number (SSN) or Employer Identification Number (EIN)

UPIN - Unique Physician Identification Number - this number is assigned to physicians and non-physician practitioners to identify the referring or ordering physician on Medicare claims. EACH PROVIDER/SUPPLIER WILL ONLY RECEIVE ONE FOR THEIR ENTIRE CAREER.

For additional information on Provider Enrollment, please visit the CMS Provider Enrollment web site.


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