Providers may receive a temporary Provider Transaction Access Number (PTAN) for the enrollment with a limited effective date to help support the relief of the national COVID-19 public health emergency.

Once the epidemic has subsided, Medicare will deactivate the COVID-19 issued PTANs when the President declares the disaster is over.

Medicare will grant emergency enrollment if the following conditions are met:

1. the physician or non-physician practitioner must be enrolled as such in the Medicare program,
2. the physician or non-physician practitioner must possess a valid license to practice in the State which relates to his or her Medicare enrollment,
3. the physician or non-physician practitioner is furnishing services – whether in person or via telehealth – in a State in which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity, and
   1. the physician or non-physician practitioner is not affirmatively excluded from practice in the State or any other State that is part of the 1135 emergency area.

Please complete the Disaster Privileging application and provide the following information.

1. SSN
2. First/Last Name/Middle Initial
3. DOB
4. Type 1 NPI
5. State where you are physically located and providing services
6. Specialty
7. Medical school and graduation date
8. State license information
9. Correspondence Address

Once you complete and submit your Disaster Privileging application, UCSF’s Health Plan Enrollment (HPE) Team will help contact Noridian Healthcare Solutions, our Northern California Medicare Administrator Contractor (MAC), and register/request emergency enrollment on your behalf. The information provided above will be used/disclosed for enrollment purposes.

Physicians and non-physician practitioners will be assigned an effective date as early as March 1, 2020. They may bill for services furnished on or after the effective date.

An applicant or provider that seeks to enroll under a Section 1135 waiver is required to meet the following modified enrollment requirements and procedures:  The applicant or provider must have treated a Medi-Cal beneficiary who has been affected by the current national COVID-19 public health emergency.

1.    Please complete the Disaster Privileging application, sign the Medi-Cal Attestation Form, and be sure to attach a current Driver’s License or other valid government issued ID. 
2.    Our Health Plan Enrollment team then creates a Provider Application for Enrollment (PAVE) account using information from your disaster privilege application. A PAVE account is needed to prepare your online Medi-Cal enrollment application. 
3.    We will need your final e-signature and review once the Medi-Cal enrollment has been drafted.  

We will follow up with you via e-mail to get this signature. 
 

Providers who successfully enroll will be granted enrollment for only 60 days, retroactive to March 1, 2020. Please note the 60 day emergency enrollment period may be extended in 60 day increments, in accordance with the Section 1135 waiver.

Should the waiver period be extended, no further action will be required on behalf of the approved provider.