May 27, 2014
Important Provider Enrollment Updates Announced in CMS Change Request (CR) 8682: Effective June 3, 2014
In CR 8682, CMS announced various section updates to the Program Integrity Manual (PIM) (Pub. 100-08), chapter 15. *Two revisions are significant for the Provider Enrollment process and are found under the following sections:
- Form CMS-855A and Form CMS-855B Signatories, section 18.104.22.168.6 and 8, and
- Delegated Officials, section 22.214.171.124 and 12
*Social Security Number
- To be an authorized or delegated official, the person MUST have and MUST submit his/her social security number (SSN).
Note: An Individual Taxpayer Identification Number (ITIN) CANNOT be used in lieu of an SSN in this regard.
*Certification Statement Development
- The provider's initial submission of a certification statement for a particular application requires the submission of BOTH the signature page and the page containing the certification terms.
- When the contractor develops for missing or additional information and the provider MUST submit a newly-signed certification statement, ONLY the actual signature page is required; the additional page containing the certification terms need not be submitted unless the contractor requests it.
Reminders - Certification Requirements
For CMS-855A and CMS-855B initial and revalidation applications, the certification statement MUST be signed and dated by an authorized official of the provider. (Section 15.1.1 of the manual contains a definition of "authorized official.") Here is a summary:
- The provider can have an unlimited number of authorized officials, so long as each meets the definition of an authorized official.
- Section 6 of the Form CMS-855 MUST be completed for each authorized official.
- An authorized official MUST be a 5 percent direct owner, chairman of the board, etc., of the enrolling provider.
- One cannot use his/her status as the chief executive officer, chief financial officer, etc., of the provider's parent company, management company, or chain home office as a basis for his/her role as the provider's authorized official.
Please ensure that key personnel in your office/facility are aware of the changes.