Provider Enrollment Frequently Asked Questions

Who do I call if I have problems accessing the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) even though I have a PECOS User ID and password?

You should contact the Centers for Medicare & Medicaid Services (CMS) External User Services (EUS) Help Desk at 1-866-484-8049.

I am a Rural Health Clinic provider and submit Part A claims to Cahaba GBA, can I use PECOS?

At this time, Internet-based PECOS cannot accommodate initial applications submitted by Federal Qualified Health Centers, Rural Health Clinics, and End-Stage Renal Disease Facilities.; they will be available at a future date. For additional information, please visit http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/OrganizationOverview.pdf .

The CMS-855A Medicare Enrollment Application states that the National Provider Identifier (NPI) must be submitted. Our organization has not yet obtained the NPI. Can the form be submitted without this?

CMS requires submission of a copy of the NPI documentation with the CMS-855A application. This can be obtained from the National Plan and Provider Enumeration System (NPPES). NPI information is accessible on the Web-site at https://nppes.cms.hhs.gov/NPPES/

For questions on the NPI, contact the Enumerator at 1-800-465-3203 or TTY 1-800-692-2326. The NPI and Medicare identification number must also be identified in Section 4 of the CMS-855A application. The provider should obtain the NPI prior to submitting the CMS-855A application since it cannot be approved until the NPI requirement is met.

The CMS-855A Medicare Enrollment application states that the Electronic Funds Transfer (EFT) agreement must be submitted. Our organization does not want payments to be sent electronically. Will the application be accepted without this agreement?

A completed Form CMS-588, Authorization Agreement for EFT, is mandatory with submission of the CMS-855A enrollment application. The provider must submit this form with the application. The application cannot be approved if the EFT requirement is not met. If the provider already receives payments electronically, and is not making a change to its banking information, the CMS-588 is not required. Note that if the provider does not have a prior approved 855 application on file, and needs to submit an EFT form and/or make a special payments change in Section 4B, the entire application is required to be completed. Refer to the CMS Web site for the EFT form.

Do we need to revalidate our enrollment information?

The Centers for Medicare and Medicaid Services (CMS) may require you to submit or update your enrollment information at some time in the future. The Medicare contractor will notify you when it is time for you to revalidate your enrollment information. You do not need to submit a revalidation application until you have been contacted by your contractor to do so. For further information on the revalidation requirements, refer to the April 21, 2006, Federal Register.

What is an audit intermediary?

A. The audit intermediary (AI) is the Medicare contractor assigned by the Centers for Medicare and Medicaid Services (CMS) that is responsible for reviewing and auditing the provider's Medicare cost reports to ensure compliance with the principles of Medicare reimbursement and determining final settlement of the cost report. The AI is also responsible for reviewing the CMS-855A application.
Refer to the CMS website for the contractor jurisdiction maps that identify the current fiscal intermediary for each state, and the RHHI (Regional Home Health Intermediary) for each state. Cahaba is identified on the maps as BCBS AL (Cahaba).

Cahaba (GBA) is the claims intermediary for our provider. Since the CMS-855A for a change of information was sent to the audit intermediary for review, how will this change get made in Cahaba's claims system?

When submitting the application to the AI, please request that the AI notify Cahaba of the change(s) when approved. Once this notification is received, Cahaba's system will be updated.

Is an entire CMS-855A application needed for submission of a change of information, such as a practice location?

If the provider's enrollment information is not included in the CMS Provider Enrollment Chain and Ownership System (PECOS), the entire CMS-855A application needs to be completed, along with all supporting documentation, as outlined in Section 17 of the application PECOS was implemented for Part A on July 29, 2002. If the provider has not submitted an application since this date, a complete application should be submitted. If the provider is uncertain as to when a submission was made, submit the complete application. If the CMS-855A is not completed in full and all attachments submitted as required, the application will be returned.

We are uncertain whether the situation we will be encountering is a change of ownership or a reorganization. How can we obtain assistance in determining this?

The CMS Regional Office (RO) makes the determination of whether a particular circumstance constitutes for Medicare purposes, whether a change of ownership or is simply a reorganization. Prior to submitting the CMS-855A, please contact the CMS RO in the region where the provider's facility is located. To obtain the appropriate RO's address and/or phone number, go to the CMS web site.

When going through a change of ownership, when does Medicare begin making payment to the new owner?

After the CMS-855A process is complete and CMS has issued the CMS-2007, tie-in notice that documents approval of the change of ownership, the contractor can load the updated information into the appropriate systems. When this is complete, the new owner will receive reimbursement.

Additional frequently asked questions and answers are posted to the CMS Web site and the Medicare A Newline Newsletter.

If you have a provider enrollment question that has not been answered on this Web site or in any of the sources referenced, please use our Contact Page.

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Page last updated: December 31, 2009