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Provider Enrollment Review Process
Typically, initial enrollment, changes of ownership, acquisitions/merges, consolidations, and full 855-A forms applications are processed within 60 calendar days of receipt. All other application types are generally processed within 45 calendar days of receipt. Extenuating circumstances may extend these time frames. The following summarizes the review process.
- A prescreen review will be made within 15 calendar days of receipt. The application will be returned if general acceptability requirements (e.g., not signed or signature not original, full 855A not submitted if required, etc.) are not met.
- If information is missing or includes incorrect data, a request for
information will be issued.
- Requested information must be submitted within one to two weeks from the date of the request letter.
- If requested information is not received, or is incomplete, the application will be rejected and the provider will need to resubmit a new 855A application.
- Once the application review is complete and it is determined that all requirements are met, enrollment information is entered into the CMS database (Provider Enrollment Chain and Ownership System (PECOS)).
- Your facility will be notified that a recommendation of approval or denial has been sent to the State Agency and the CMS Regional Office (RO).
- The State Agency will conduct a survey in the event one is warranted and will notify CMS of the recommendation.
- The CMS RO will issue the final determination via a CMS-2007 certification notice (also known as a Tie-In Notice).
Note: There are no time frame requirements for the State Agency and the CMS RO; therefore, once the contractor recommendation is issued, the State Agency and CMS RO process may take six to nine months, or longer.
- The CMS RO also issues the final determination to the contractor. Once the contractor receives notification, the provider’s enrollment information will be entered into the Fiscal Intermediary Standard System (FISS).
It is the applicant’s responsibility to submit the CMS-855A enrollment
application information timely and in accordance with CMS
requirements. Applications
are processed in the order of receipt, and Cahaba cannot accommodate requests
to expedite the review process.
Page last updated: May 17, 2010
