Provider Enrollment Review Process
Institutional providers that are initially enrolling in Medicare, adding a practice location, or revalidating their enrollment information per 42 CFR §424.515, are required to submit an application fee. If using Internet-based PECOS to submit your CMS-855A enrollment application, the fee is paid as part of that process. If you submit a paper CMS-855A application, the application fee is paid on the Centers for Medicare & Medicaid Services (CMS) website.
For paper applications, if the fee is paid before the application is submitted, please include a copy of the payment confirmation with your application. Your application will not be accepted until confirmation of the application fee is received. If the application fee is not submitted with the application, your facility will be sent a letter requesting payment. Payment must be received within 30 days of the date of the letter. Failure to submit the application fee within this time period will result in initial enrollment or new location applications to be denied pursuant to 42 CFR 424.530(a)(9), or a current Medicare provider's billing privileges will be revoked pursuant to 42 CFR 424.530(a)(6).
Fingerprint-Based Background Checks
Fingerprint-based background checks are generally completed on individuals with a 5 percent or greater ownership interest in a provider or supplier that falls under the high risk category. A 5 percent or greater owner includes any individual that has any partnership in a high risk provide or supplier.
CMS-855A applications are typically completed within 45-60 calendar days from receipt. Extenuating circumstances may extend these time frames. The following summarized the review process.
Note: If requested information is not received, or is incomplete, the application will be rejected and a new 855A application must be submitted.
Once the application review is complete, CGS will send a letter of recommendation (approval or denial) to the provider, State Agency, and the CMS Regional Office (RO).
Note: CGS does not take any further action on the initial application until the tie-in notice is received.
In addition, some provider types may require a site visit once the tie-in notice is received. As a result, if any information on the initial enrollment changes, providers are required to submit updates.
It is the applicant's responsibility to submit the CMS-855A enrollment application information timely and in accordance with CMS requirements. Applications are processed in the order of receipt, and CGS cannot accommodate requests to expedite the review process.
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