Additional Form CMS-855B Processing Information

10.3.1.2.10 – Additional Form CMS-855B Processing Information (Rev. 11839; Issued: 02-09-23; Effective: 04-21-23; Implementation: 06-19-23) The processing alternatives in section 10.3.1.2.10(E) are in addition to, and not in lieu of, any other processing alternatives described in this chapter or another CMS directive. These processing alternatives also apply notwithstanding any instruction in this chapter to the contrary. As stated in section 10.3, however, some of the application data elements and verification procedures that have previously been subject to a processing exception/alternative may no longer be so or are moot under PECOS 2.0. (See section 10.3 for a discussion of such data and procedures.) In such situations, the contractor shall disregard the exception/alternative and follow the instructions in section 10.3 and section 10.3.1.2 through 10.3.1.2.9. A. Supporting Documents (Section 17) See the Supporting Documents Section of the Form CMS-855B as well as section 10.3 for information concerning supporting documents. B. Attachment 1 for Ambulance Service Suppliers In section D of Attachment 1 of the Form CMS-855B, the “Land,” “Air,” and “Marine” boxes need not be checked (or developed) if the type of vehicle involved is clear. In addition, the contractor need not develop for the written statement signed by the President, Chief Executive Officer, or Chief Operating Officer of the airport from where the aircraft is hangared that furnishes the name and address of the facility. See section 10.2.2.10 of this chapter for more detailed processing instructions on Attachment 1. C. Attachment 2 for Independent Diagnostic Testing Facilities See section 10.2.2.4 of this chapter for more detailed processing instructions on Attachment 2. D. Attachment 3 for Opioid Treatment Programs See section 10.2.7 of this chapter for more detailed processing instructions on Attachment 3. E. Provider-Based Entities The contractor shall adhere to the following regarding the enrollment of provider-based entities: • 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. • 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. • 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 the processing of any practice location addition applications pending receipt of provider-based attestations or CMS approval of provider-based status. F. Additional Processing Information and Alternatives 1. Unsolicited Additional Information If the supplier submits additional/missing/clarifying data or documentation on its own volition (i.e., without being contacted by the contractor), the contractor shall include this additional data/documentation in its overall application review. Any new or changed information that a supplier 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. 2. Information Disclosed Elsewhere If a data element on the supplier’s Form CMS-855B application is missing but the information is disclosed (1) elsewhere on the application or (2) in the supporting documentation submitted with the application, the contractor need not obtain the missing data via an updated Form CMS-855B page and a newly-signed certification statement; no further development – not even by telephone – is required. The following information, however, must be furnished in the appropriate section(s) of the Form CMS-855B, even if the data is identified elsewhere on the form or in the supporting documentation: • All ownership and managing control information in the Organizational or Individual Ownership and/or Managing Control sections of the Form CMS-855B • Except as otherwise stated in section 10.6.6 of this chapter, any final adverse action data requested in the Final Adverse Legal Actions/Convictions Section and the Organizational and Individual Ownership and/or Managing Control/Final Adverse Legal Action History sections of the Form CMS-855B • All legal business names (LBN) or legal names (NOTE: If an application is submitted with a valid NPI-PTAN combination but (1) the LBN field is blank, (2) an incomplete or inaccurate LBN is submitted, or (3) the applicant includes a DBA name in the Practice Location Information section of the Form CMS-855B -- and the contractor is able to confirm the correct LBN based on the NPI-PTAN combination provided, the contractor need not develop.) • All tax identification numbers (TIN) • NPI-legacy number combinations in the Practice Location Information section of the Form CMS-855B (NOTE: The contractor may use the shared systems, PECOS, or its provider files as a resource to determine the PTAN or NPI before developing with the supplier.) • Supplier type in the Identifying Information section of the Form CMS-855B 3. Supporting Documentation Resubmission If the supporting documentation currently exists in the supplier’s file, the supplier need not submit that documentation again during the enrollment process. The contractor shall utilize the existing documentation for verification. Documentation submitted with a previously submitted enrollment application (or documentation currently uploaded in PECOS) qualifies as a processing alternative, unless stated otherwise in this chapter or another CMS directive. Also, per section 10.6.19(H) of this chapter, the contractor shall document in PECOS that the missing information was found elsewhere in the enrollment package. (This excludes information that must be verified at the current point in time (i.e., a license without a primary source verification method.) In addition, the contractor shall not utilize information submitted along with opt-out applications for enrollment application processing or vice-versa. 4. City, State, and ZIP Code If an address (e.g., correspondence address, practice location) lacks a city, state or zip + four, the contractor can verify the missing data in any manner it chooses. In addition, the contractor can obtain the zip + four from either the U.S. Postal Service or the Delivery Point Validation in PECOS. 5. Inapplicable Questions The supplier need not check “no” for questions that obviously do not apply to its supplier type. 6. Authorized/Delegated Official Telephone Number The telephone numbers in these sections can be left blank. No further development is needed.