CMS-10114: Medicare Advantage Provider Enrollment

The CMS-10114 is the form used by providers to enroll with specific Medicare Advantage (MA) plans. Unlike Original Medicare enrollment — where you file with CMS through PECOS and get billing privileges for the entire Medicare program — Medicare Advantage enrollment is plan-specific.

Each Medicare Advantage plan (Aetna Medicare, Humana Gold Plus, UnitedHealthcare AARP, etc.) has its own provider network. The CMS-10114 initiates that plan-specific enrollment. Most MA plans layer their own credentialing requirements on top of the CMS-10114.

How Medicare Advantage provider enrollment differs from Original Medicare

If you want to see both Original Medicare and Medicare Advantage patients, you need both: Original Medicare enrollment via CMS-855I/B, AND separate MA enrollment with each plan whose patients you want to treat.

Who files the CMS-10114

The CMS-10114 is used by providers who are applying to participate in a specific Medicare Advantage plan’s network. This includes:

• Individual physicians and non-physician practitioners
• Group practices (the organization enrolls, with individual providers credentialed separately)
• Facilities (hospitals, SNFs, home health agencies applying to MA plan networks)
• Any provider type that wants to be in-network with a specific MA plan

Step-by-step: MA plan enrollment process

Step 1: Confirm your Original Medicare enrollment is active Most MA plans require you to have active Original Medicare billing privileges before you can join their network. Complete your CMS-855I/B enrollment first.

Step 2: Identify which MA plans you want to join In many markets, there are 5–20+ MA plans operating. You don’t need to join all of them — identify the plans with significant membership in your service area. Your practice management system may show you which plans your patients are on.

Step 3: Contact the plan’s provider relations department MA plans often have their own online credentialing portals or applications. Obtain the current enrollment materials from each plan. The CMS-10114 may be the starting point, but most plans have supplementary credentialing applications.

Step 4: Complete the CMS-10114 The form collects:

• Provider name, NPI, and specialty
• Practice location(s)
• Original Medicare PTAN
• Licensure information
• Malpractice insurance information
• Any adverse history disclosures

Step 5: Complete plan-specific credentialing Most MA plans use a credentialing process that parallels or extends the CMS-10114:

• Council for Affordable Quality Healthcare (CAQH) ProView profile — most plans require an up-to-date CAQH profile and will pull primary source verification from CAQH
• Medical staff or credentialing committee review (for hospital-based providers)
• Practice site visit (for some plan types and specialties)
• Contract negotiation (rates and terms)

Step 6: Sign the participation agreement MA plans have participation agreements (contracts) that govern reimbursement rates, claims submission requirements, referral rules, and network expectations. Review carefully before signing.

Step 7: Receive plan-specific provider ID Once credentialed, the plan issues you a provider ID or confirms your network participation. Store this — you’ll need it for claims submission.

CAQH ProView: the credentialing shortcut

Most commercial health plans and many MA plans use CAQH ProView for primary source verification of provider credentials. Maintaining a current CAQH profile significantly speeds up MA credentialing:

• Complete and attest your CAQH profile before applying to MA plans
• CAQH profiles must be re-attested every 120 days — set a calendar reminder
• CAQH collects: licensure, board certification, malpractice history, work history, hospital privileges

An expired CAQH attestation is one of the most common reasons MA credentialing applications stall. Verify your CAQH profile is current before initiating any MA plan credentialing.

⚠️ Risk flags

⚠️ Each MA plan is a separate contract. Joining one MA plan doesn’t put you in network with others. You must apply to each plan separately. Treating a patient who is a member of an MA plan you haven’t joined and contracted with means you’re out of network — patient may face higher cost sharing and you face reimbursement uncertainty.

⚠️ MA plans can remove you from their network. Unlike Original Medicare (where disenrollment requires CMS action), MA plans can terminate your participation with contractually-specified notice. Network adequacy requirements limit plans’ ability to do this capriciously, but it happens.

⚠️ Credential expiration mid-contract. If your CAQH profile expires, your malpractice lapses, or your state license expires while you’re in an MA network, the plan may suspend your participation. Keep all credentials current and reflected in CAQH.

⚠️ MA rates vs. Medicare rates are different. MA plans negotiate rates with providers. These rates may be above or below Original Medicare fee schedule rates. Review the plan’s fee schedule before signing the contract.

Processing timeline

MA plan credentialing typically takes 30–90 days per plan, depending on:

• Whether your CAQH profile is current
• Whether the plan uses CAQH or requires manual credentialing
• Plan-specific credentialing committee meeting schedules

Larger plans (UnitedHealthcare, Humana, Aetna) may have more streamlined processes. Regional and smaller plans often take longer.

After approval

• You receive a plan-specific effective date
• Configure your billing system with the plan-specific billing requirements
• Verify you understand the plan’s referral and prior authorization requirements
• Plans will typically send you an updated provider directory listing

Related pages

• MCO Overview — Medicare Advantage Plans
• Contracting with Medicare Advantage Plans
• MCO vs. Original Medicare
• CMS-855I — Individual Provider Enrollment

Questions about joining specific Medicare Advantage networks? Ask Mae → Free Metolius Health enrollment audit →