(Practice Location Information) – Form CMS-855B

10.3.1.2.4 – Section 4 (Practice Location Information) – Form CMS-855B (Rev. 13355; Issued: 08-13-25; Effective: 05-05-25; Implementation: 05-05-25) A. Reporting and Verification Policies 1. ZIP Code – The supplier must submit the 9-digit ZIP Code for each practice location listed. 2. Practice Location Name - For suppliers paid via the Multi-Carrier System (MCS), the practice location name entered into PECOS shall be the legal business name. (Beginning with PECOS 2.0, however, the DBA name can be entered as the practice location name.) 3. Practice Location Verification – Except as stated otherwise in this chapter or in another CMS directive, the contractor shall verify that the practice locations listed on the application actually exist and are valid addresses with the United States Postal Service (USPS). PECOS includes a USPS Address Matching System Application Program Interface (API), which validates address information entered and flags the address if it is determined to be invalid, unknown, undeliverable, vacant, unlikely to deliver mail (No-Stat), a CMRA (i.e., UPS Store, mailboxes, etc.), or a known invalid address false positive. These address types are not permitted in PECOS and are flagged upon entry. 4. Phone Number Verification - The contractor need not verify the supplier’s telephone number listed on the application, though the supplier must report one. If it does not, the contractor shall develop for a phone number using the procedures outlined in this chapter. 5. Special Certified Supplier Instructions (ASCs and Portable X-Ray Suppliers (PXRS)) - If the supplier’s address and/or telephone number cannot be verified, the contractor shall request clarifying information from the supplier. If the supplier states that the facility and its phone number are not yet operational, the contractor may continue processing the application. However, it shall indicate in its recommendation letter that the address and telephone number of the facility could not be verified. For purposes of PECOS, the contractor can temporarily use the date the certification statement was signed as the effective date. 6. Specific Section 4 Subsection Policies a. Practice Location Type - In Section 4A, if the “type of practice location” checkbox is blank, the contractor can confirm the information via the PCV, e-mail, or fax. b. Section 4B - If neither box is checked and no address is provided, the contractor can contact the supplier by telephone, the PCV, e-mail, or fax to confirm the supplier’s intentions. If the “special payments” address is indeed the same as the practice location, no further development is needed. If, however, the supplier wants payments to be sent to a different address, the address in Section 4B must be completed via the Form CMS-855B. c. Updated Questionnaire - If the supplier (1) is adding a practice location and (2) is normally required to complete a questionnaire in the Form CMS-855B specific to its supplier type (i.e.: physical or occupational therapist groups), the entity must submit an updated questionnaire to incorporate services rendered at the new location. d. Section 4E – If the “Check here” box in Section 4E is not checked and no address is provided, the contractor can contact the supplier by telephone, the PCV, e-mail, or fax to confirm the supplier’s intentions. If the base of operations address is the same as the practice location, no further development is needed. If the supplier indicates that the base of operations is at a different location, the address in Section 4E must be furnished via the Form CMS-855B. e. Section 4F - If the vehicle certificates are furnished but the applicable Form CMS-855B sections are blank, the contractor can verify via telephone, the PCV, e-mail, or fax that said vehicles are the only ones the supplier has. B. Do Not Forward (DNF) Unless instructed otherwise in another CMS directive, the contractor shall follow the DNF initiative instructions in Pub. 100-04, chapter 1, section 80.5. Returned paper checks, remittance notices, or EFT payments shall be flagged if returned from the post office or banking institution, respectively, as this may indicate that the supplier’s “special payment” address (the Practice Location Information section of the Form CMS-855B) or EFT information has changed. The supplier should submit a Form CMS-855B to change this address; if the supplier does not have an established enrollment record in PECOS, it must complete an entire Form CMS-855B. (For DMEPOS suppliers, the DME MAC is responsible for obtaining, updating, and processing Form CMS-588 changes.) If a supplier is closing the business and has a termination date (e.g., is retiring), the contractor will likely need to make payments for prior services rendered. Since the practice location has been terminated, the contractor may encounter a DNF message. If so, the contractor should request the supplier to complete the “special payment” address section of the Form CMS-855B and to sign the certification statement. The contractor, however, shall not collect any other information unless there is a need to do so. C. Remittance Notices/Special Payments For new enrollees, all payments must be made via EFT. The contractor shall thus ensure that the supplier has completed and signed the Form CMS-588 and shall verify that the bank account complies with Pub. 100-04, chapter 1, section 30.2. If an enrolled supplier that currently receives paper checks submits a Form CMS-855 change request – no matter what the change involves – the supplier must also submit: • A Form CMS-588 that switches its payment mechanism to EFT. (The change request cannot be processed until the Form CMS-588 is submitted.) All future payments (excluding special payments) must be made via EFT. • The contractor shall also verify that the bank account complies with Pub. 100-04, chapter 1, section 30.2. (Once a supplier changes its method of payment from paper checks to EFT, it must continue using EFT. A supplier cannot switch from EFT to paper checks.) The “special payment” address may only be one of the following: • One of the supplier’s practice locations • A P.O. Box • The supplier’s billing agent. The contractor shall request additional information if it has any reason to suspect that the arrangement – at least with respect to any special payments that might be made – may violate the Payment to Agent rules in Pub. 100-04, chapter 1, section 30.2. • Correspondence address • A lockbox. The contractor shall request additional information if it has any reason to suspect that the arrangement - at least with respect to any special payments that might be made - may violate the Payment to Agent rules in Pub. 100-04, chapter 1, section 30.2. D. Out-of-State Practice Locations (The policies in this section 10.3.1.2.4(D) apply unless CMS instructs otherwise in this chapter or in another directive.) If a supplier is adding a practice location in another state that is within the contractor’s jurisdiction, a separate, initial Form CMS-855B enrollment application is not required if the following 5 conditions are met: (i) The location is not part of a separate organization (e.g., a separate corporation, partnership); (ii) The location does not have a separate TIN and LBN; (iii) The state in which the new location is being added does not require the location to be surveyed; (iv) Neither the new location nor its owner is required to sign a separate certified supplier agreement; and (v) The location is not an IDTF, ASC, or other supplier type that must individually and separately enroll each of its locations. Consider the following scenarios: EXAMPLE 1 - The contractor’s jurisdiction consists of States X, Y and Z. Jones Group Practice (JGP), Inc., is enrolled in State X with 3 locations. It wants to add a fourth location in State Y. The new location will be under JGP, Inc. JGP will not be establishing a separate corporation, LBN, or TIN for the fourth location. Since there is no state agency or SOG Location involvement with group practices, all five conditions are met. JGP can add the fourth location via a change of information request, rather than an initial application. The change request must include all information relevant to the new location (e.g., licensure, new managing employees). (For paper applications only---and to the extent required---the contractor shall create a separate PECOS enrollment record for the State Y location.) EXAMPLE 2 - The contractor’s jurisdiction consists of States X, Y and Z. Jones Group Practice (JGP), Inc., is enrolled in State X with 3 locations. It wants to add a fourth location in State Y but under a newly-created, separate entity - Jones Group Practice, LP. The fourth location must be enrolled via a separate, initial Form CMS-855B. EXAMPLE 3 - The contractor’s jurisdiction consists of States X, Y and Z. Jones Group Practice (JGP), Inc., is enrolled in State X with 3 locations. It wants to add a fourth location in State Q. Since State Q is not within the contractor’s jurisdiction, a separate initial enrollment for the fourth location is necessary. E. Unavoidable Phone Number or Address Changes Unless CMS specifies otherwise, any change in the supplier’s phone number or address that the supplier did not cause (e.g., area code change, municipality renames the supplier’s street) must still be updated via the Form CMS-855B.