Provider Enrollment with A/B MAC (B)

40.1 - Provider Enrollment with A/B MAC (B) (Rev. 1027, Issued: 08-11-06, Effective: 09-11-06, Implementation: 09-11-06) The designated A/B MAC (B) shall designate a consistent method of labeling all IHS- related enrollment applications. For Form CMS-855B (11/01) submission, under item 2.A.1 Supplier Identification, check the “Other” box and manually indicate IHS, tribes or tribal organization on the line provided. The designated A/B MAC (B) shall follow these enrollment requirements: • All applications are subject to the same processing times as all other provider enrollment applications; • If a person or entity has been issued a Drug Enforcement Agency (DEA) certification, submit a copy of the certification for the person and the entity. Continue to process these applications because these entities are owned by another governmental agency. Obtain a copy of the DEA certification; • All IHS entities may not have an actual street address. Continue to process these applications because these entities are owned by another governmental agency. In addition, obtain directions to the location of the entity and/or other descriptions, leading to the location. The following conditions must be met when the IHS computer generated enrollment form is utilized: • All pages of the submitted computer generated Form CMS-855 must display the official watermark date; • Accept these applications in hard copy only, no electronic copies; • Accept only completed applications and not “fragments” or pieces of an application; • The IHS generated Form CMS-855 will only be accepted by the designated A/B MAC (B) for the purposes of enrolling IHS physicians and practitioners for Medicare Part B payment. As of October 1, 2002, only the 11/01 version of the Form CMS-855 will be accepted. Any electronic generated forms will have to be generated from the CMS Provider Enrollment Web site. Any other enrollment forms submitted by IHS, tribes or tribal organizations after October 1, 2002, will be returned to the provider. The provider will then have to complete a new Form CMS-855 and submit to the designated A/B MAC (B) in order to enroll. Instructions for completing the Form CMS-855S, DMEPOS Supplier Application, can be found in Pub. 100-08, Medicare Program Integrity Manual, Chapter 10. For more information on the Form CMS-855S, see §40.3 of this chapter.