8, 13, and 14 (Billing Agencies, Contact Persons, and

10.3.1.2.6 – Sections 8, 13, and 14 (Billing Agencies, Contact Persons, and Penalties for Falsifying Information) - Form CMS-855B (Rev. 11839; Issued: 02-09-23; Effective: 04-21-23; Implementation: 06-19-23) Except as otherwise stated, the PECOS policies in section 10.3 supersede those in sections 10.6.8 and 10.6.9 of this chapter. A. Billing Agency Information (Section 8) (Regarding the Billing Agency Information section of the Form CMS-855B, see section 10.6.8 of this chapter.) If the telephone number is blank, the contractor may verify it with the supplier via telephone, the PCV, e-mail, or fax. If all of the Billing Agency Information section is blank (including the check box), no additional development is necessary. B. Contact Person (Section 13) (Regarding the Contact Person section of the Form CMS-855B, see section 10.6.9 of this chapter.) If this section is completely blank, the contractor need not develop for this information and can simply contact an authorized or delegated official. If neither box is checked but the contact person information is incomplete (e.g., no telephone number listed), the contractor may either (1) develop for this information by telephone, the PCV, e-mail, or fax, or (2) contact an authorized or delegated official. There is no existing option on the Form CMS-855B to delete a contact person. The contractor shall therefore accept a contact person’s end-date via telephone, the PCV, e-mail, fax, or mail from the individual supplier, an authorized/delegated official, or a current contact person on file. The contractor shall document in PECOS who requested the termination, how the request originated (e-mail, phone, or fax), and when the request occurred. However, the provider must still report all contact person additions via the Form CMS-855B. C. Penalties for Falsifying Information (Section 14) Please refer to the Penalties for Falsifying Information section of the Form CMS-855B for an explanation of penalties for deliberately furnishing false information on this application to gain or maintain Medicare enrollment.