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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

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)

This section must be completed for all managing employees of the provider. This includes W-2 managing employees, contracted managing employees, and individuals who have operational/managerial control of the provider but aren't W-2 or contracted employees. The provider is required to have at least one managing employee. This is required for initial enrollment, CHOW (Buyer), reactivation and revalidation.

CMS 588 Agreement

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.

Supporting Documents

A preprinted voided check (temporary or starter checks are not acceptable) or written letter from the bank on bank letterhead confirming the name on the account, the bank's routing number, the account number, and the type of account signed by a bank officer is required to be submitted.

CMS Internet Based PECOS Applications

CMS 855A Application

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.

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.

CMS 588 Agreement

Supporting Documents

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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