Additional Form CMS-855A Processing Information

10.3.1.1.13 – Additional Form CMS-855A Processing Information (Rev. 11839; Issued: 02-09-23; Effective: 04-21-23; Implementation: 06-19-23) A. Supporting Documents Section See the Supporting Documents section of the Form CMS-855A as well as section 10.3 of this chapter for information concerning supporting documents. B. Unsolicited Additional Information If the provider submits additional/missing/clarifying data or documentation on its own volition (i.e., not pursuant to a contractor request), the contractor shall include this additional data/documentation in its overall application review. Any new or changed information that a provider submits prior to the date the contractor finishes processing a previously submitted change request constitutes a separate change request rather than an update to the original change request. The contractor may process both changes simultaneously; however, the contractor shall process the first submitted change to completion before processing the second one to completion. C. Non-Enrollment Functions In some instances, the contractor cannot forward an application to the state until it performs certain non-enrollment functions pertaining to the application (e.g., the reimbursement unit needs to examine patient listing data). The PECOS status may be changed to “approval recommended” prior to the conclusion of the non-enrollment activity if: (1) the contractor has completed all required enrollment actions; and (2) the non-enrollment action is the only remaining unperformed activity. D. Multiple Providers under a Single TIN It is important for contractors to remember that multiple providers and suppliers --- even those of different types --- may have the same TIN; for instance, a CORF, an HHA, and a hospice might have a similar TIN. However, each provider must submit a separate Form CMS-855A application. They cannot all be reported via one enrollment, though, for PECOS submissions, consolidated applications may be permitted. (See section 10.3(B)(4) for more information.) (For paper applications only, the contractor must create a separate enrollment record for each provider under the same TIN). E. Future Effective Dates If the contractor cannot enter an effective date into PECOS because the provider, practice location, etc., is not yet established, the contractor may use the authorized official’s date of signature as the temporary effective date. Once the actual effective date is established, the effective date in PECOS can be changed. F. Provider-Based Entities The contractor shall adhere to the following regarding the enrollment of provider-based entities: 1. Certified Provider or Certified Supplier Initially Enrolling – Suppose an HHA or other certified provider or certified supplier wishes to enroll and become provider-based to a hospital. The provider/supplier must enroll with the contractor as a separate entity. It cannot be listed as a practice location on the hospital’s Form CMS-855A. 2. Certified Provider or Certified Supplier Changing its Provider-Based Status – If a certified provider or certified supplier is changing its status from provider-based to freestanding or vice versa, it need not submit any updates to its Form CMS-855A enrollment. 3. Group Practice Initially Enrolling – If a group practice is enrolling in Medicare and will become provider-based to a hospital, the group generally must enroll via the Form CMS-855B if it wants to bill for practitioner services. The group would also need to be listed or added as a practice location on the hospital’s Form CMS-855A. 4. Group Practice Changing from Provider-Based to Freestanding – In this situation, the hospital should submit a Form CMS-855A change request that deletes the clinic as a practice location. The group may also need to change the type of clinic it is enrolled as; this may require a new Form CMS-855B. 5. Group Practice Changing from Freestanding to Provider-Based – Here, the hospital must submit a Form CMS-855A change request adding the group as a practice location. The group may also need to change the type of clinic it is enrolled as; this may require a new Form CMS- 855B. Unless CMS instructs otherwise, the contractor shall not delay its processing of any practice location addition application pending receipt of a provider-based attestation or CMS approval of provider-based status.