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Provider Enrollment

Most Common Reasons for Delays in Application Processing

The following information provides monthly data showing errors with Online PECOS and paper CMS-855 applications submitted to CGS for processing.

Please share the following with your credentialing staff to avoid submitting enrollment applications incorrectly.

CMS 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.

Please ensure that you are submitting your applications either via PECOS or by mail. Faxed and emailed applications cannot be accepted and will delay the processing of your application.

CMS 855A Application

Application Fee

Institutional providers that are (1) initially enrolling in Medicare, (2) adding a practice location, or (3) revalidating their enrollment information per 42 CFR §424.515, must pay an application fee in an amount prescribed by CMS.

The application fee must be paid electronically. Visit the Medicare Enrollment websiteExternal website.

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

Ensure that the first name, middle initial, last name, social security number, and date of birth completed in Section 6A matches the information on file with the Social Security Administration. If an individual has recently changed their name due to marriage or divorce, the new name should only be completed if the change has been reported to the Social Security Administration. Typographical errors are commonly found in the social security number and date of birth so we recommend that you review the information completed before submission to avoid processing delays.

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

This section must be completed for all individuals who have a 5% or greater direct or indirect ownership of (including a 5% or greater mortgage or security interest in the provider), any general partnership interest in, 10% or greater limited partnership interest in, and/or managing control of the provider. This is required for initial enrollment, CHOW (Buyer), reactivation and revalidation.

Supporting Documents

Ensure that the legal business name and/or TIN on the NPPES system, on the CMS-855A application, and on IRS support all match. We cannot complete the processing of your application unless this information matches exactly.

CMS 588 Agreement

Part II – Account Holder Information

The legal business name completed on the EFT Form CMS-588 must match the name on file with the Internal Revenue Service (IRS). Do not list the day-to-day doing business as name as the legal business name.

Part V – Authorization

The EFT agreement must be signed by an individual who is on file within the enrollment as an authorized or delegated official. If the individual who signs the EFT isn't on file, he/she must be added as an authorized or delegated official via the CMS-855A application and meet CMS requirements for an authorized/delegated official.

CMS Internet Based PECOS Applications

CGS has identified the common reasons for delays in processing CMS applications, submitted by Internet Based PECOS. 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.

CMS 855A Application

Application Fee

Institutional providers that are (1) initially enrolling in Medicare, (2) adding a practice location, or (3) revalidating their enrollment information per 42 CFR §424.515, must pay an application fee in an amount prescribed by CMS.

The application fee must be paid electronically. Visit the Medicare Enrollment websiteExternal website.

Ownership Interest & Managing Control Information (Individuals)

Titles should be completed for all individuals designated as directors, officers, and managing employees in the Individual Control section. This is required for initial enrollment, CHOW (Buyer), reactivation, revalidation, and when submitting changes or additions to directors, officers, or managing employees.

Ownership Interest & Managing Control Information (Individuals)

This section must be completed for all officers and directors of the provider if the provider is organized as a corporation (whether for-profit or non-profit). This is required for initial enrollment, CHOW (Buyer), reactivation and revalidation.

CMS 588 Agreement

Supporting Documentation

For submissions that include the Electronic Funds Transfer (EFT) Agreement, a voided check or written letter from the bank confirming the name on the account, the bank's routing number, the account number, and the type of account is required to be submitted.

You may upload the voided check/bank letter as a supporting document prior to submitting the Internet Based PECOS Application.

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