Corporate

August 2018 Common Reasons for Delays in Processing HHH CMS 855 Paper Applications

CGS has identified the common reasons for delays in processing CMS paper applications. As you are completing the enrollment applications, please review to ensure you are completing the forms correctly and submitting the necessary supporting documents to avoid any delays in processing your request.

Choose from the application-specific topics below to expand and collapse the development reason details.

CMS 855A Application

Section 3 – Final Adverse Legal History

The question in Section 3.1 must be completed by checking Yes or No identifying whether your organization under any current or former name or business identity has ever had a final adverse action imposed against it. This must be submitted for initial enrollment, CHOW (Buyer), reactivation, revalidation, and changes of information.

Section 5 – Ownership Interest and/or Managing Control Information (Organizations)

If there are organizations that have ownership and/or managing control, submit an organizational chart identifying all of the entities and their relationship with the provider and with each other. This is required for initial enrollment, CHOW (Buyer), reactivation, revalidation, and when submitting changes or additions to organizational ownership.

Section 6A and 6B – Ownership Interest and/or Managing Control Information (Individuals)

When reporting individuals who are no longer associated with the provider, ensure the delete box at the beginning of section 6A is marked and the effective date of deletion is completed.

The question in section 6B.1 must be completed by checking Yes or No identifying whether the individual in section 6A under any current or former name or business identity has ever had a final adverse action imposed against him/her.  This must be submitted for initial enrollment, CHOW (Buyer), reactivation, revalidation, and changes of information.

Supporting Documents

Submit a copy of the current state license. If the state requires your provider type to be licensed, current license information must be on file. If the license on file with CGS has expired, you must provide an updated copy of your license.

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