GME MEDICARE & TENNCARE/MEDICAID GUIDANCE

Resident/Fellow MEDICARE Enrollment

CMS requires that all providers, to include residents, and fellows, must be enrolled as a Medicare provider to be able to order/refer items or services to Medicare beneficiaries. If you plan to order/refer, please follow the guidance below to enroll. Please make sure the correct form, CMS 8550 is completed. At this time there is no CMS option for centrally enrolling House Staff and we ask that you please complete enrollment individually. Please carefully read all information below.

  • Initial/New enrollment is needed only if you are enrolling in Medicare for the first time.
  • You may complete enrollment up to 60 days prior to your VUMC residency/fellowship start date.
  • If you have been previously enrolled in Medicare, do not enroll again. A "change of information" needs to be completed. Please see How to Navigate through PECOS (Change of Information) to request a change via PECOS. This is applicable regardless of whether your enrollment was in another state or for another specialty. To update specialty from a previous enrollment, please also complete a "change of information."
  • For enrollment via PECOS, if you have an account with NPPES (for your NPI), you are not a new user, and can use the same username/password and log on.
  • For new enrollment, answer each question as it pertains to you, however most will indicate they are “registering for the sole purpose of order/referring/prescribing.”

 

  • If you do not hold an individual/independent physician license (applicable to most VUMC residents and fellows), you are considered “Physician not employed by any entity.”  Most residents/fellows at VUMC operate under a license exemption. You will select "unlicensed resident" in PECOS or leave the license information section blank for paper and will need to attach a confirmation letter provided by your program coordinator. Coordinators, a template for this letter can be found here. Coordinator name/signature on the letter should be sufficient. This letter is only required for individuals who do not have a license.
  • If you do hold an individual/independent physician license, you are considered “Licensed Resident not employed by any entity.”  You will include your license information in the applicable section.

 

  • Please use your program address in lieu of your home address. Address information may be made public so we advise against using home address. Your approval letter will be sent to the email provided.
  • For "contact" (required online/optional for paper enrollment) you can list yourself.
  • For "specialty" list the program you are currently in. Do not select "unspecified".
  • Palmetto GBA is the TN MAC (Medicare Administrative Contractor) and can answer enrollment questions. They can be reached at 877-567-7271, 8am-6pm ET, Monday thru Friday. Follow prompts for Enrollment/Part B.
  • For those who also have an appointment as Instructor, such as Clinical Fellow Instructors in non-ACGME fellowships, enrollment is completed by VUMC Payer Enrollment.

House Staff need to enroll either online or on paper - see below for guidance on either option.

Online Enrollment

Link: https://pecos.cms.hhs.gov/pecos/login.do#headingLv1

Under "My Associates," click to start a new application, then select: "Eligible Ordering, Certifying, and Prescribing Physicians, and Other Eligible Professionals"

PECOS Help Desk 866-484-8049 for technical/system issues

Paper Enrollment

Link to main website: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Ordering-and-Certifying

Mailing address for paper applications: Part B Provider Enrollment (AG-310), PO Box 100306, Columbia, South Carolina 29202-3306

 

House Staff TennCare/MEDICAID

A valid TennCare/Medicaid ID number is required for participation in TennCare, Tennessee’s Medicaid program.

House Staff with no individual license

For House Staff who do not have an individual license, registration/ Tenncare/Medicaid IDs do not need to be obtained individually. GME completes Provider Registration with the State of TN for all unlicensed House Staff, which TN uses to assign individual Medicaid IDs.

House Staff with an individual license

Resident/Fellows who have an individual medical license and are seeking a Tenncare/Medicaid ID must register as outlined below in “Provider Registration”.  Individual registration cannot be completed with a future start date/prior to your VUMC start date.

Provider Registration

House Staff with an individual license and seeking a Medicaid ID must register through the TennCare electronic registration portal at https://www.tn.gov/tenncare/providers/provider-registration.html.  Using the link for “Individual (Provider Person) Provider Registration Information”, enter the information requested.

For detailed instructions, please see “Step by Step Guide to Electronic Registration” at https://www.tn.gov/content/dam/tn/tenncare/documents/GroupRegistrationInstructions.pdf

For Assistance, please contact Provider Registration via email at Provider.Registration@tn.gov or by phone at 1-800-852-2683.

Guidance for Completing:

  • Professional IDs - When entering license information, be sure to enter both the effective date as well as the end date.  Not entering the effective date will delay processing.
  • Specialties - Choose the specialty type from the specialty list.  If you are board certified, complete this section as well.
  • Practice Locations – This is one of the most critical sections for ensuring the Medicaid ID is assigned correctly.
    • Enter the name of the “Group” you will be practicing under along with Address, City, State, Zip, Country and County.  Please select Sole Proprietor as you are not tied to a Group.
    • For the “Tax ID” section under the practice location, you do not need to enter the “Practice Name”.
      • For the “Tax ID” the provider should enter their “SSN” or “their FEIN”.  Do not enter the group “Tax ID” as that will cause and error and prevent the provider ID from being assigned.
      • The “Type of Tax ID” should be “Individual”
      • There must be a primary practice location with a “Yes checked in the profile under “Office Type”.  Please use Vanderbilt University Medical Center.
    • For the “NPI” section, under the Practice Location, the provider can check “Yes” and enter the group NPI and Group Name.  If those are unknown, check “No” and proceed.
    • For “Practice Affiliation” the provider should check “Yes” that they are working at the practice location./Practice Name”.  Complete the remaining information in this section.  Indicate if you are practicing at the address. (All yes/no questions must be answered).
    • There are additional sub-sections within the “Practice locations” section.  While not all of the sub-sections are required, it is recommended that they be completed.
  • Hospital Privileges – In many cases this answer will most likely be “No”.
  • Credentialing Contact – You must enter at least one “Primary Credentialing Contact” and indicate the choice by checking “Yes/No” in this section.  This will be the person primarily responsible for ensuring the CAQH data is up to date. Please consider listing your own email address here and please do not list the GME email. Once you are registered through CAQH, the email address provided for the credentialing contact will receive a welcome email.
  • Credentialing Office Address – Unless you have been credentialed through Provider Support Services please use the GME office address below. If you have been credentialed through Provider Support Services and have a secondary faculty appointment you may find that you have already been registered when you try to enter your information. If not, please proceed to obtain the Medicaid ID and complete the CAQH registration.
    Vanderbilt University Medical Center
    Graduate Medical Education
    303 Light Hall
    Nashville, TN 37232-5283
    Phone: (615) 322-4916
    Fax: (615) 343-1496
    Email Address:
    per above, we encourage you to use your own email address
    (Please note that the GME Office will not be able to make updates or changes for you but you must enter something here.)
  • Professional Liability Insurance – Complete
    Professional Liability coverage is provided by the Vanderbilt University Medical Center Self-Insured Trust and the policy number is #36. The address is 2525 West End Avenue #700, Nashville, TN 37203. Incident Limit is $5,500,000 and the Aggregate Limit is “Amount in excess of $20,000,000”. We sent a file to the coordinators containing your Certificates of Coverage and we also have these available from the GME office. Please check with your coordinator for a scanned copy which must be uploaded to complete the CAQH process.
  • Employment Information / Professional References – Complete any sections needed
  • Disclosure – Application cannot be processed if this is not completed
  • Authorize – Choose “Global” or “All healthcare organizations…” or “Only the healthcare…” that you choose.

After all information is entered, choose “Review” and the system will review the application and indicate if there are any errors that must be fixed prior to processing the CAQH application.  There is supporting documentation which must be uploaded prior to the CAQH provider data being sent to TennCare or any other organization.  Once all errors are cleared, complete the attestation process.

In order to maintain a Medicaid ID, the CAQH profile must remain in an “Attested” status.  CAQH requires provider to “re-attest” every 120 days.  If the ID is not “re-attested” it goes into “expired attestation”.  Providers in “expired attestation” are at risk of having their Medicaid IDs terminated.