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Provider Enrollment FAQs

What is DNF?
The Do Not Forward (DNF) is a flag placed on the provider or supplier’s enrollment that stops claims payments from being issued due to paper checks, remittance notices, or EFT payments that have been returned from the post office or banking institution.  A DNF flag is also placed on the provider or supplier’s enrollment if notification is received from the bank that the account information is incorrect or the account is closed.

How do I get a DNF removed?
CMS requires corrections to all addresses and/or banking information before the contractor can remove the Do Not Forward (DNF) flag and begin paying the provider or supplier again.  Therefore, the provider or supplier should:

  • Submit a CMS-855 change of information for any address changes and/or a CMS-588 to correct banking information.
  • If the provider or supplier does not have an established enrollment record in PECOS, a CMS-855 application and a CMS-588 EFT form must be submitted.

How do I prevent receiving a DNF?
When the provider/supplier signs the Certification Statement on the CMS-588 application they “agree to notify the Medicare contractor of any future changes to the information contained in this application in accordance with the timeframes established in 42 C.F.R.  424.156.”

In order to prevent a DNF from being placed on your account you should notify your Medicare contractor immediately when there are changes in your address or banking information.

Where does one find help in completing the forms?
On this website are tutorials to help in the process including a checklist for the correct forms and applicable sections to complete. One can complete the forms electronically from the CMS website, with edit check features. However, once printed, the signature and date needs to be originally signed before mailing. Please make a copy for your records also prior to mailing.After submission, the analysts at Cahaba GBA Provider Enrollment will notify you if your application is incomplete and will request from you the specific information needed to process your enrollment form(s).Tips for getting your application processed quicker!
How does one qualify for a Medicare Part B provider identification number?
CMS offers a listing of providers who are eligible to apply for a PIN: Medicare Enrollment HomeMost physicians, practitioners, suppliers, healthcare groups and organizations are eligible to apply, but it is important to read the information concerning each specialty or supplier type to determine requirements for enrollment in the Medicare program.Providers not eligible to receive a Medicare PIN include acupuncturists, speech pathologists, marriage and family therapists, marriage and family certified counselors, psychological assistants, registered nurses, licensed addiction counselors and social worker assistants.
Where does one get Medicare Part B application form(s)?
The forms may be downloaded from the Internet at the CMS website.
  • CMS 855I for individual practitioners
  • CMS 855B for groups
  • CMS 855R for reassignment of benefits

The CMS web site offers the forms in both an electronic file and a Portable Document Format (PDF) file. Customer Service may also be contacted at 1-877-567-7271 for a hardcopy packet to be sent.

How do I get an National Provider Identifier(NPI) number? Is a National Provider Identifier number also necessary for a group?
Apply online at https://nppes.cms.hhs.gov or call the Enumerator Customer Service at 1-800-465-3203 with any questions. NPIs are now required to be submitted with all provider enrollment applications. NPIs are also necessary for groups/organizations for billing Part B reimbursement.
What are the steps for a physician/practitioner to join a group for Medicare reimbursement?
Both the individual (CMS 855I) and the group (CMS 855B) must first complete the appropriate CMS 855 application form. In addition, the 855R must be submitted at the same time as the 855B and/or 855I for appropriate reassignment of group member payments. If the group is enrolled and the physician/practitioner is already enrolled, and the individual simply wants to join the group, the 855R must be submitted to add the additional reassignment.
Are there other documents required to be submitted with the application?
There may be certain documentation that is also required to include (i.e., diploma, license, national certification, etc.) depending on the form you are completing or your particular situation. Cahaba GBA has prepared a listing of Provider Types and Checklist Requirements to assist applicants with correctly submitting all required information when the initial application is submitted.
If one is already enrolled in Medicare in another state, is it necessary to complete another application?
Yes. One will need to complete a new 855I enrollment form when rendering services within Cahaba GBA’s jurisdiction. Also, the physician/practitioner must complete an 855R form when joining a group.
Can a copy of the CMS 855 be submitted?
Yes, a photocopy of the CMS 855 is acceptable; however, the signature must be an original. Stamped, faxed or copied signatures are not acceptable. Although the form may be photocopied, it is unlawful to alter it in any manner or use whiteout in this section.
Which officials in a non-profit organization are required on the CMS 855?
Managing/Directing Employees
In a non-profit environment, each member of the governing board should be reported in the Managing/Directing Employees section of the CMS 855B.Owners
Any individual who owns at least five percent of a non-profit organization must be reported in the Owner Information section of the CMS 855.
What should one do to leave a group in terms of notification to Medicare?
If a physician/practitioner leaves a group, the physician/practitioner or the group should complete the CMS 855R. The group must complete sections 1, 2, 3, and 7 or sections 1, 2, 3, and 5 must be completed by the physician/practitioner.If one is joining another group, a separate CMS 855R is required.
Who may sign the certification statement on the application?
The individual enrolling must sign the certification statement of a CMS 855I. An authorized official of the organization applying must sign the CMS 855B. The individual reassigning benefits and an authorized official must sign the 855R. If changes are being made subsequent to the initial enrollment, the signature of delegated or authorized official is allowed. Examples of allowed and non-allowed authorized officials are as follows:
Allowed Not Allowed Conditional – In certain situations, these titles are not allowed.
Officer, President, Medical Director, Vice President, Treasurer, Chairman,  Enrollment Specialist, Director (Board of Directors), Owners Officer Manager, Insurance Specialist, Credentialing Specialist, Manager, Agent, Consultant Administrator – Administrator of a Hospital or Public Health Unit is allowed. The Administrator of any other type of organization is not allowed.Secretary – A Secretary (officer) of a corporation is allowed. Any other type of secretary is not allowed.
How soon can I receive my provider number or expect a change to be completed?
How do I check the status?
CMS requires its contractors to process 80 percent of initial applications within 60 calendar days of receipt or sooner, 90% within 120 days, and 99% percent of applications should be processed within 180 calendar days of receipt. If the contractor has to request additional information, the contractor will contact the applicant initially by telephone to expedite the collection of any missing or additional information. Changes or additional reassignments are completed 80% within 45 days, 90% within 60 days, or 99% within 90 days.Once an application is received, a notification letter is sent to the contact person which includes a tracking number. Within the ‘Enroll/Update your records’ section of this website, one can click on the “Check Status of Current Application” to check the status with that unique tracking number.
What is the Medicare Unique Physician Identification Number (UPIN), how does a physician/provider get one, and when is a UPIN required?
Whenever an applicant completes the enrollment application process for Medicare Part B, the information is submitted to the National Registry using the PECOS Medicare provider enrollment system. A UPIN is then assigned and returned to Cahaba GBA.A notification letter with both the Cahaba GBA Medicare Part B PIN and the issued UPIN is sent to the applicant, depending on the specialty of the provider.Occasionally a hospital may require its physicians to obtain a UPIN as admitting privileges policy although they may not perform services for Medicare beneficiaries. Under these circumstances, Cahaba GBA will issue both the PIN and the UPIN, but will terminate the PIN after assigning the UPIN since there is no intention for billing Medicare.
Define authorized official.
The authorized official is an appointed official to whom the provider/supplier has granted the legal authority to enroll in the Medicare program, to make changes, and/or updates to the supplier’s status in the Medicare program (e.g., new practice locations, change of address, etc) and to commit the supplier to fully abide by the laws, regulations, and program instructions of Medicare. The authorized official must be the supplier’s general partner, chairman of the board, chief financial officer, chief executive officer, president, direct owner of 5% or more of the supplier, or must hold a position of similar status and authority within the supplier’s organization.
Who is a delegated official?
A delegated official is any individual who has been delegated, by the provider/supplier’s “”Authorized Official,” the authority to report changes and updates to the provider/supplier’s enrollment record. A delegated official must be a managing employee (W-2) of the supplier or have a 5% or greater direct ownership interest, or any partnership interest, in the enrolling supplier. Delegated officials are persons who are delegated the legal authority by the authorized official reported in Section 15B to make changes and/or updates to the supplier’s status in the Medicare program. Cahaba GBA may request evidence indicating that the delegated official is an actual employee of the provider.
Can a group bill for services rendered by an independently contracted Physician Assistant (PA)?
Yes, as long as the group is enrolled in the Medicare program.
If the applicant had the certification statement signed when first submitting the application, but later additional information is needed, is it necessary to resign and date the statement?
Yes, but the section can be faxed if the original is on file for comparison of signature.
Application Section needed Section resigned/dated
855I or 855B any 15
855R 2 and 4 7
855R 3, eff. date in 4 6
How do I change my address or update other provider enrollment information?
All changes must be reported within 90 days. A CMS 855I is required for an individual and a CMS 855B is required for an organization to make any changes to the provider record. The Medicare identification number must be entered in Section 1.A.1. The Social Security number or tax ID must also be entered in Section 1.A.2. The change box of the appropriate section(s) of the application must be checked. A signed certification statement (section 15) signed by an authorized official or delegated official must also be completed.
Where do I send my completed application form(s)?
Completed forms should be mailed to the following addresses: 
 
Medicare Part B Provider
Provider Enrollment
Post Office Box 6169
Indianapolis, IN  46206-6169
 
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