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May 27, 2014

Important Provider Enrollment Updates Announced in CMS Change Request (CR) 8682: Effective June 3, 2014

In CR 8682External PDF, 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 15.5.15.2.6 and 8, and
  • Delegated Officials, section 15.5.16.7 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.


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