Stay of enrollment

Effective May 30, a provider or supplier may be subjected to a stay of enrollment if they are deficient in one provider enrollment requirement which can be remedied by submitting a provider enrollment application. A stay of enrollment is a preliminary, interim status representing a pause in enrollment.

During a stay of enrollment, or stay, you will remain active in Medicare, but we will reject any claim submitted with a date of service within the stay period. Your stay of enrollment will not last more than 60 days. 

Some examples of when a stay of enrollment may be implemented:

• Provider failed to timely report a change in address
• Supplier didn't respond to a revalidation request
• Independent diagnostic testing facility failed to comply with a supplier standard
• A supplier failed to timely report a change in address of an organizational owner
• A supplier failed to report the deletion of a managing employee

Note: If there is a non-compliance that can’t be corrected by the submission of a provider enrollment application, a stay of enrollment can’t be imposed. 

If a stay of enrollment has been placed on your enrollment record, you will be notified by hard-copy mail, email, and fax, if applicable. To have the stay of enrollment removed, you must fix the non-compliance with Medicare by submitting the applicable Medicare application.

• For example: Your clinic group practice recently changed practice locations and did not notify Medicare. We implemented a stay of enrollment because you did not report a change in practice location. To have the stay of enrollment removed and be able to continue billing Medicare, you will have to submit a change of information enrollment application to update your practice address. 

Update: Providers have reported that stay of enrollment letters have been found in their spam folder when sent via email. Please ensure your spam folder is monitored for any provider enrollment correspondence.

If you believe you meet all provider enrollment requirements and the stay of enrollment should not have been imposed, submit a provider enrollment rebuttal. Refer to your stay of enrollment letter for instructions on how and where to submit the rebuttal.

For more information, please review:

MLN Matters article MM13449, Stay of enrollment