CMS-855 Series Enrollment Forms: Information and Processing

10.3.1 - CMS-855 Series Enrollment Forms: Information and Processing (Rev. 11839; Issued: 02-09-23; Effective: 04-21-23; Implementation: 06-19-23) Each CMS-855 Series form is used to enroll a specific provider or supplier type for a specific purpose. This section 10.3.1 et seq, discusses various data elements on the Form CMS-855 applications. Not every data element on the forms is discussed in section 10.3.1 et seq.; only those elements that warrant additional instructions are mentioned. Except as stated otherwise, the instructions in 10.3.1 et seq.: (1) support and do not supplant the instructions and information within the applications themselves; and (2) do not supersede federal regulations concerning Medicare provider screening and enrollment. Regardless of whether the data element in question is discussed in this section, the contractor shall adhere to all instructions in this chapter 10 in terms of the collection, processing, and verification of all data elements on the Form CMS-855 applications, unless stated otherwise in this chapter or in another CMS directive. (This includes processing alternatives and clock stoppages.) CMS reiterates, however, that in the event of any inconsistency or conflicting direction between an instruction in section 10.3.1 et seq. and an instruction in section 10.3, the latter takes precedence; this includes, for example, guidance pertaining to: (1) enrollment data submission, acquisition, development, processing, and validation; and (2) communicating with the provider/supplier). For purposes of these sections, and unless otherwise indicated, the term “approval” includes recommendations for approval. In addition: • The contractor is advised that the Form CMS-855 section numbers outlined in this section 10.3 et seq. may not be reflected (or may be different) in PECOS 2.0. However, the instructions for each denoted application section in 10.3 et seq. apply to the concomitant enrollment information in PECOS 2.0. For instance, if certain practice location information in Section 4 of the current Form CMS-855B is captured in a different section of PECOS 2.0, the contractor shall still follow the Section 4 practice location instructions. Chapter 10 will eventually be restructured to more closely align with the process of a provider/supplier’s completion of a PECOS application. • In situations where the contractor may capture or develop for information via several means, one of which is the PCV, the contractor is strongly encouraged to use the latter as its information acquisition or development vehicle. If the contractor needs additional information concerning the forms or the processing thereof, it may contact its PEOG BFL.