To expedite the enrollment process, you can begin collecting copies of documents that you will need to include when you submit the completed enrollment form:

	A copy of the facility's home-state license to cover the application date through the current date.
	A copy of the DEA certificate to cover the application date through the current date.
	A copy of your FEIN documentation showing both the name and number preprinted (a W-9 is not sufficient for enrollment purposes).
	A copy of your Medicare award or participation letter.
	A list of the facility's or program's owners and/or Board of Directors with addresses.
	A copy of your NPI assignment notification.
	If enrolling for inpatient services, a Rate Verification Form completed by the facility's home-state rate setting agency.

• Out-of-State (OOS) Hospital Enrollment Package Request Form
• Out-of-State (OOS) Rate Verification Form
• Inpatient Provider Manual
• Clinic Provider Manual
• ETIN