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MED

Credentialing Tips Regarding Government Entities

May 21, 2019 09:15AM ● By Alyssa McGinnis

By Lavonne McKee

The government is continually making updates to prevent Medicare fraud. This includes the new NPPES/NPI numbers and revalidation of Medicare enrollment. Here are a few things to check.

  • IRS CP 575 or Address Change Letter - Must have your current name, address and EIN/TIN number. If you are using a doing business as name, this must be included.

  • NPPES/NPI Number - Must match the IRS information word for word, punctuation and EIN/TIN number, for both NPI types one and two.

  • Medicare / PECOS - Must match IRS information word for word, punctuation and the EIN/TIN number. Medicare also requests a copy of your IRS Letter with the current information.

  • Medicaid – Must match IRS information word for word, punctuation and the EIN/TIN number.

  • TriCare/HealthNet – Is now verifying the information you enter into their system to match your Medicare information. So be sure that you get the information entered correctly when enrolling or re-enrolling.

These are all government entities and the need to be completed in the order below for a smooth transition. When your facility or providers have an update of location or name, please be sure to change the information in these government entities.


Lavonne McKee is President and CEO of Credentialing USA, Inc. in Sioux Falls.