NPEAST and NPWEST: Which Enrollment Contractor Handles Your State

When a DME supplier submits a CMS-855S, it does not go to CMS directly or to the contractor that pays its claims. It goes to one of two National Provider Enrollment contractors: NPEAST for the eastern region and NPWEST for the western region. They replaced the National Supplier Clearinghouse on November 7, 2022 (CMS Transmittal 11743, Change Request 12951). As of that transmittal, CMS awarded NPEAST to Novitas Solutions and NPWEST to Palmetto GBA, and the current CMS-855S names the same two companies.

Which states does NPEAST handle?

Per the transmittal and the 855S: Alabama, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, West Virginia, Wisconsin, the District of Columbia, Puerto Rico and the U.S. Virgin Islands.

Which states does NPWEST handle?

Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Louisiana, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wyoming, American Samoa, Guam and the Northern Mariana Islands.

The competitive bidding contractor's contact page, updated for Round 2028, routes supplier enrollment questions using the same two lists.

Is it based on where I ship or where I am?

Where the location is. The 855S assigns the contractor "based on your geographic location," and every physical location is enrolled separately (42 CFR 424.57(b)(1)). A supplier with a warehouse in Texas and a store in Florida files one 855S with NPWEST for Texas and another with NPEAST for Florida. A mail-order supplier in Ohio that ships to every state files with NPEAST only, and lists every state it serves in section 2D, with the licenses each requires.

How are the enrollment contractors different from the DME MACs?

They do different jobs. The enrollment contractors process enrollment: they "Validate that suppliers meet all supplier standards," check that suppliers are accredited for the products on their application, and keep the central repository of DMEPOS enrollment data (MLN905710). The four DME Medicare Administrative Contractors process claims. The 855S groups states by DME MAC jurisdiction, A through D, in section 2D, and those jurisdiction lines do not match the east-west enrollment split; Texas, for example, is in NPWEST for enrollment but in Jurisdiction C on the 855S.

The competitive bidding contractor's guidance puts it simply: contact NPEAST or NPWEST "for assistance with supplier enrollment," and the DME MAC "for the area where the beneficiary resides" for claim status, billing and coverage questions. Billing belongs to our sister company, White Glove Medical Billing; enrollment is ours.

What do the contractors actually decide?

• Whether an application is complete, and what to request in development (you generally have 30 days to answer).
• Screening: license verification, database checks, the site visit and, for new suppliers, owner fingerprints (42 CFR 424.518).
• Approval, which issues the supplier number (PTAN) for the location, or denial.
• Revocations and deactivations, and decisions on many corrective action plans and reconsiderations.
• Bond reviews, revalidation processing and changes of information.

They also check accreditation directly: CMS says the contractors "may contact your AO directly" during enrollment for location and ownership changes. But CMS also says the contractors and accreditors "are completely independent, so compliance with 1 entity doesn't guarantee compliance with the other."

Does the contractor publish licensing guidance?

Yes, as a guide. The 855S says the contractors' websites "may offer guidance on licensure requirements," and the competitive bidding contractor points bidders to a DMEPOS Licensure Database Directory on the enrollment contractors' sites, while warning that "this is a guide only" and that keeping licenses current in PECOS is the supplier's responsibility. Our state license requirements page cites the state statutes and rules directly, and getting your state licenses into PECOS covers the upload.

How do we work with both contractors?

We prepare and, as your approved PECOS surrogate, submit applications to whichever contractor covers each location, and we can be listed as the section 13 contact so development requests reach us. Your authorized official signs. The Medicare DMEPOS Enrollment Package is $1,295 for the first location and $595 for each additional location (see pricing). Contractor names and contacts change over time; check the current CMS-855S before mailing anything.