Cahaba GBA Provider Enrollment Top Reasons for Delayed Applications

A high percentage of applications are delayed because the correct information has not been supplied or submitted by the appropriate person. We hope to expedite the enrollment process by informing our provider community of the most common reasons an application can be delayed.

1. Missing and/or Unauthorized Signatures
   
   Applications must be signed and dated by the appropriate individuals which are the authorized and delegated officials. The Authorized Official is an appointed official (e.g., chief executive officer, chief financial officer, general partner, chairman of the board, or direct owner) to whom the organization has granted the legal authority to enroll it in the Medicare program, to make changes or updates to the organization's status in the Medicare program, and to commit the organization to fully abide by the statutes, regulations, and program instructions of the Medicare program. A Delegated Official is an individual who is delegated by the “Authorized Official,” the authority to report changes and updates to the enrollment record. The delegated official must be an individual with an “ownership or control interest” in (as that term is defined in section 1124(a)(3) of the Social Security Act), or be a W-2 managing employee of the supplier.

   It is important that Cahaba is notified each time there is a change in the Authorized or Delegated official initially listed during the enrollment process. If the individual that signed, and dated section 15 (certification statement) is not the individual on file, an updated signature page (section 6 of the 855B) must be submitted along with the new signature (section 15 of the 855B) page. If an unauthorized individual signed, a new signature must be submitted and it cannot be signed above or under the signature of the unauthorized individual. The signature date should not be older than 90 days from the date Medicare receives the application.

2. Individual Application precedes Group Application
   Many Applicants send Cahaba an 855I or 855R prior to enrollment of the group which they are joining. Cahaba must return applications not submitted in the required combination if the missing form is not submitted within 15 days.

   Action	Problem	Resolution
   Applicant joining a Current Group they think is Enrolled	Group is not established with Cahaba Medicare under the same EIN	Ensure group exists with Cahaba Medicare prior to Applicant's submission of Forms. If Group does not exist with Cahaba , submit the 855B along with the applicant's forms
   Applicant is joining a new Group	Forms are not submitted together causing a delay and possible return	Submit the Group form and member forms together
   Applicant is enrolling their own business but the business is Incorporated.	Applicant only submits the 855I form	Applicant must submit the 855I if they are the sole owner of the business. If there is more than one owner they must submit 855B for their business and an 855R. If the applicant is new or established, Cahaba will determine if the 855I is also needed.

3. Missing Individual and/or Group Applications. Cahaba will return application(s) to the applicant if the missing CMS 855 form is not submitted within 15 days of receipt of the initial form

   • A new group member submits an 855I form without submitting the 855R form.
   • A new group member submits an 855R form without submitting the 855I form
   • A new group submits an 855B form without submitting group member applications (855I's) and Reassignments (855R's)

4. NPI information Missing

   Each provider (individual, group and organization) is required to have an NPI prior to making a change to their file or enrolling with Medicare. This NPI must be on the 855 forms and an NPI letter should be submitted with the application. If a provider has their own business and it is incorporated, that business needs an NPI as well as the provider. Even providers that are terming their provider number must have the NPI before the application can be processed.

5. Electronic Funds Transfer (EFT) form Missing

   Each provider (group, organization or independent provider) that is enrolling or making a change to their enrollment record must submit the EFT 588 Form. If this form is missing when submitted with an 855B or 855I (solo), it must be mailed in within 15 days of receipt. Non-receipt of missing forms delays the processing of the application. The signature on this form must be original.

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