Provider Enrollment Frequently Asked Questions
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/ 
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.
Additional Section Links
- Provider Enrollment Introduction
- About Medicare Provider Enrollment
- Provider Enrollment Packet
- Provider Enrollment Frequently Asked Questions
- Provider-Based Status Determinations
- Provider-Based Status Background
- Electronic Funds Transfer (EFT)
Page last updated: May 8, 2008