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Education Makes the Difference

Education Makes the Difference

Education Makes the Difference

Part A Fundamentals of Provider Enrollment

CMS-855A Overview

Published September 2010

Important

The information contained in this presentation was current as of August 2010.

Slide 2

Obtaining Medicare Approval

The applicant completes and submits a CMS-855A enrollment application and all supporting documentation to its Fee-for-Service (FFS) contractor. The FFS contractor reviews the application and submits a recommendation for approval or denial to the state agency and CMS Regional Office (RO).

The CMS RO makes the final decision regarding program eligibility. The RO also works with the Office of Civil Rights.

The state agency conducts a survey. Based on the survey results, the state agency makes a recommendation.

Slide 3

Avoid Delays in Your Enrollment

To avoid delays in the enrollment process, you should:

· Complete all required sections as indicated in the instructional pages of the CMS-855A form. See page 6 of the application and "CMS-855A Section-Specific Tips." Note: If you enrolled in Medicare but have never submitted the CMS-855, you are required to submit a complete application, i.e., all sections of the CMS-855A and mandatory supporting documentation. · Ensure that the legal business name shown in Section 2 matches the name on the tax documents. · Ensure that the National Provider Identifier (NPI) was obtained with the legal name as documented on file with the Internal Revenue Service (IRS). · Ensure the practice location reported on the CMS-855A agrees with the practice location submitted for obtaining the NPI.

Slide 4

Avoid Delays in Your Enrollment (Cont.)

· Enter your NPI in reported in all applicable sections on the CMS-855A. · Be sure to indicate whether you are changing, adding or deleting the information and enter the effective date, especially in Sections 4, 5, 6, 15 and 16. · Ensure that the application is signed and dated by the authorized and/or delegated official. · Be sure that the individual listed as the contact person is accessible throughout the enrollment process. Ensure that the phone number and fax number are valid. Note: The individual(s) listed should be available for inquiries and able to obtain all required and necessary information for completion of the enrollment application process.

Slide 5

Additional Information

For additional information regarding the Medicare enrollment process, visit: http://www.cms.gov/MedicareProviderSupEnroll The information you provide on this application will not be shared. It is protected under 5 USC Section 552(b)(4) and/or (b)(6). For more information, see the Privacy Act Statement on the last page of this application.

Slide 6

Mail Your Application

The Medicare FFS contractor (also referred to as a Fiscal Intermediary (FI) or Medicare Administrative Contractor (MAC)) that services your state is responsible for processing your enrollment application. TrailBlazer Health Enterprises, LLC Provider Enrollment P.O. Box 650458 Dallas, TX 75265-0458

Slide 7

Types of Errors

As we review the CMS-855A, we will point out three types of errors:

· Data missing, noted with a red arrow. · Data incorrect, noted with a green arrow. · Trended error (an error that appears repeatedly within the form), noted with a yellow arrow.

Slide 8

Types of Errors (Cont.)

As we review the CMS-855A, we will point out three types of errors:

· Data missing, noted with a red arrow. · Data incorrect, noted with a green arrow. · Trended error (an error that appears repeatedly within the form), noted with a yellow arrow.

Slide 9

Types of Errors (Cont.)

As we review the CMS-855A, we will point out three types of errors:

· Data missing, noted with a red arrow. · Data incorrect, noted with a green arrow. · Trended error (an error that appears repeatedly within the form), noted with a yellow arrow.

Slide 10

Types of Errors (Cont.)

As we review the CMS-855A, we will point out three types of errors:

· Data missing, noted with a red arrow. · Data incorrect, noted with a green arrow. · Trended error (an error that appears repeatedly within the form), noted with a yellow arrow.

Slide 11

New Enrollees

You are a new enrollee if:

· You are enrolling with a particular FFS contractor for the first time. · You are undergoing a change of ownership where the new owner will not be accepting assignment of the Medicare assets and liabilities of the seller/former owner.

Slide 12

Section 1: Basic Information

Slide 13

Section 1: Basic Information (Cont.)

Slide 14

Section 2: Identifying Information

Slide 15

Section 2.A

Slide 16

Section 2.B.1

Slide 17

Section 2.B.1 (Cont.)

Slide 18

Section 2.B.2

Slide 19

Section 2.B.2 (Cont.)

Slide 20

Section 2.C

Slide 21

Sections 2.D and 2.E

Slide 22

Sections 2.F, 2.G and 2.H

As a new enrollee, you are not required to complete Sections 2.F, 2.G and 2.H. These will be covered later in the presentation for providers affected by these sections.

Slide 23

Section 3: Adverse Legal Actions/Convictions

This section contains information on adverse legal actions, such as convictions, exclusions, revocations and suspensions. All applicable adverse legal actions must be reported, regardless of whether any records were expunged or any appeals are pending. If you are uncertain whether an action falls within one of the adverse legal action categories or whether a name reported on this application has an adverse legal action, contact the Healthcare Integrity and Protection Data Bank. For information on how to access the Data Bank, call (800) 767-6732 or visit http://www.npdb-hipdb.com. There is a charge for using this service.

Slide 24

Section 3: Adverse Legal Actions/Convictions (Cont.)

Adverse legal actions that must be reported include:

· · · · Convictions. Exclusions. Revocations. Suspensions.

Slide 25

Section 3: Adverse Legal Actions/Convictions (Cont.)

Slide 26

Section 4: Practice Location Information

Practice location information instructions:

· Report all practice locations within the jurisdiction of the Medicare FFS contractor to which you will submit this application. · Provide the specific street address as recorded by the United States Postal Service. Do not furnish a P.O. box.

Slide 27

Section 4: Practice Location Information (Cont.)

Community Mental Health Centers (CMHCs):

· CMHCs must report all alternative sites where core services are provided (proposed alternative sites for initial enrollment and actual alternative sites for those CMHCs already participating in Medicare). · In accordance with provisions of the Public Health Service Act, a CMHC is required to provide mental health services principally to individuals who reside in a defined geographic area (service area).

Slide 28

Section 4: Practice Location Information (Cont.)

Hospitals:

· Hospitals must report all practice locations where the hospital provides services. · Do not report separately enrolled provider types such as Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs) or Rural Health Clinics (RHCs), even if these entities are provider-based at the hospital. · For example, a hospital owns an SNF and an HHA. The hospital should not list the SNF and HHA on its application, as they are not locations where the hospital furnishes services. They are providers that are separate and distinct from the hospital, and will be reported on their respective CMS-855A applications.

Slide 29

Section 4: Practice Location Information (Cont.)

Base of operations address:

· If the provider does not have a physical location where equipment and/or vehicles are stored or from where personnel report on a regular basis, complete this section with information about the location of the dispatcher/scheduler. · This situation may occur if the provider operates mobile units that travel continuously from one location directly to another.

Slide 30

Section 4: Practice Location Information (Cont.)

Mobile facility and/or portable units:

· To properly pay claims, Medicare must know when services are provided in a mobile facility or with portable units. This section is mostly applicable to providers who perform outpatient physical therapy, occupational therapy and speech-language pathology services.

A "mobile facility" is generally a mobile home, trailer or

other large vehicle that has been converted, equipped and licensed to render health care services. A "portable unit" transports medical equipment to a fixed location to render services to the patient.

Slide 31

Section 4.A: Selection

Slide 32

Section 4.A: Contact Information

Slide 33

Section 4.A: Contact Information (Cont.)

Slide 34

Section 4.A: Provider Identifiers

Slide 35

Section 4.B

Slide 36

Section 4.B: Special Payments

Slide 37

Section 4.C: Medical Records

Where do you keep patients' medical records? If you store patients' medical records (current and/or former patients) at a location other than the location in Section 4.A or 4.D, complete this section with the address of the storage location.

Slide 38

Section 4.C: Primary Location

Slide 39

Section 4.C: Secondary Location

Slide 40

Section 4.D: Base of Operations

The base of operations is the location from where personnel are dispatched, where mobile/portable equipment is stored and, when applicable, where vehicles are parked when not in use. If you are changing, adding or deleting information, check the applicable box, furnish the effective date, and complete the appropriate fields in this section.

Slide 41

Section 4.D: Base of Operations (Cont.)

Slide 42

Section 4.E: Vehicle Information

If the mobile health care services are rendered inside a vehicle, such as a mobile home or trailer, furnish the following vehicle information. If more than three vehicles are used, copy and complete this section as needed. Do not furnish information for ambulance vehicles or vehicles that are used only to transport medical equipment (e.g., when the equipment is transported in a van but is used in a fixed setting, such as a doctor's office). If you are a new enrollee, check "add."

Slide 43

Section 4.E: Vehicle Information (Cont.)

Slide 44

Section 4.F: Geographic Location

For mobile/portable providers, furnish information identifying the geographic area(s) where health care services are rendered. Note: If you provide mobile health care services in more than one state and those states are serviced by different Medicare FFS contractors, complete a separate enrollment application (CMS-855A) for each Medicare FFS contractor's jurisdiction.

Slide 45

Section 4.F.1: Initial Reporting or Additions

Slide 46

Section 4.F.2: Deletions

Slide 47

Section 5: Ownership Interest and/or Managing Organizations

Complete this section with information about all organizations that have 5 percent or more (direct or indirect) ownership interest of, any partnership interest in, and/or managing control of, the provider identified in Section 2, as well as information on any adverse legal actions that have been imposed against that organization. For examples of organizations that should be reported here, visit: http://www.cms.gov/MedicareProviderSupEnroll

Slide 48

Section 5: Ownership Interest and/or Managing Organizations (Cont.)

Managing control (information):

· Any organization that exercises operational or managerial control over the provider, or conducts the day-to-day operations of the provider, is a managing organization and must be reported. The organization need not have an ownership interest in the provider to qualify as a managing organization. · For instance, it could be a management services organization under contract with the provider to furnish management services for the business.

Slide 49

Special Types of Organizations

Governmental/tribal organizations:

· If a federal, state, county, city, or other level of government or an Indian tribe will be legally and financially responsible for Medicare payments received, the name of that government or Indian tribe should be reported as an owner. · The provider must submit a letter on the letterhead of the responsible government (e.g., government agency) or tribal organization that attests that the government or tribal organization will be legally and financially responsible in the event that there is any outstanding debt owed to CMS.

Slide 50

Special Types of Organizations (Cont.)

Non-profit, charitable and religious organizations:

· Many non-profit organizations are charitable or religious in nature, and are operated and/or managed by a board of trustees or other governing body. The actual name of the board of trustees or other governing body should be reported in this section. · Each non-profit organization should submit a copy of a 501(c)(3) document verifying its non-profit status.

Slide 51

Who to Report

All organizations that have any of the following must be reported in Section 5:

· Five percent or more ownership (direct or indirect) of the provider. · Managing control of the provider. · A partnership interest in the provider, regardless of the percentage of ownership the partner has.

Slide 52

Who to Report (Cont.)

Owning/managing organizations are generally one of the following types:

· Corporations (including non-profit corporations). · Partnerships and limited partnerships (as indicated above). · Limited liability companies. · Charitable and/or religious organizations. · Governmental and/or tribal organizations.

Slide 53

Section 5.A: Selection

Slide 54

Section 5.A: Selection (Cont.)

Slide 55

Section 5.A: Selection (Cont.)

Slide 56

Section 5.A: Details

Slide 57

Section 5.A: Details (Cont.)

Slide 58

Section 5.B: Adverse Legal History

Slide 59

Section 5.B: Adverse Legal History (Cont.)

Slide 60

Section 6: Ownership Interest and/or Managing Control (Individuals)

The following individuals must be reported in Section 6A:

· All persons who have a 5 percent or greater direct or indirect ownership interest in the provider. · If (and only if) the provider is a corporation (whether forprofit or non-profit), all officers and directors of the provider. · All managing employees of the provider. · All individuals with a partnership interest in the provider, regardless of the percentage of ownership the partner has. · Authorized and delegated officials.

Slide 61

Section 6: Ownership Interest and/or Managing Control (Individuals) (Cont.)

Please note:

· Only individuals should be reported in Section 6. For more information on "direct" and "indirect" owners, go to: http://www.cms.gov/MedicareProviderSupEnroll. · The provider must have at least one owner and/or managing employee. If there is more than one person listed in this section, copy and complete this section for each. · All partners within a partnership must be reported on this application. This applies to both general and limited partnerships.

Slide 62

Section 6.A: Selection

Slide 63

Section 6.A: Selection (Cont.)

Slide 64

Section 6.A: Selection (Cont.)

Slide 65

Section 6.A: Selection (Cont.)

Slide 66

Section 6.A: Details

Slide 67

Section 6.A: Details (Cont.)

Slide 68

Section 6.B: Adverse Legal History

Slide 69

Section 6.B: Adverse Legal History (Cont.)

Slide 70

Section 7: Chain Home Office Information

This section captures information regarding chain organizations. This information will be used to ensure proper reimbursement when the provider's year-end cost report is filed with the Medicare FFS contractor. Chain organizations are generally defined as multiple providers that are owned, leased or, through any other device, controlled by a single organization. The controlling organization is known as the chain "home office."

Slide 71

Section 7: Chain Home Office Information (Cont.)

Typically, the chain home office:

· Maintains uniform procedures in each facility for handling admissions, utilization review, and preparing and processing admission notices and bills. · Maintains and centrally controls individual provider cost reports and fiscal records. In addition, a major portion of the Medicare audit for each provider in the chain can be performed centrally at the chain home office. Note: For questions regarding requirements for a chain home office, contact the TrailBlazer Cost Report Reopening and Home Office Cost Statements department.

Slide 72

Section 7.A: Type of Action

Slide 73

Section 7.B: Chain Home Office Administrator

Slide 74

Section 7.C: Chain Home Office Information

Slide 75

Section 7.D: Business Structure

Slide 76

Section 7.E: Affiliation

Slide 77

Section 8: Billing Agency

Slide 78

Section 8: Billing Agency (Cont.)

Slide 79

Section 8: Billing Agency (Cont.)

Slide 80

Section 8: Billing Agency (Cont.)

Slide 81

Section 8: Billing Agency (Cont.)

Slide 82

Sections 9­12

Slide 83

Section 13: Contact Person

Slide 84

Section 13: Contact Person (Cont.)

Slide 85

Section 13: Contact Person (Cont.)

Slide 86

Section 13: Contact Person (Cont.)

Slide 87

Section 14: Penalties for Falsifying Information

Pages 34 and 35 of the CMS-855A outline the penalties for falsifying information within this document.

Slide 88

Section 15: Certification Statement

Authorized official:

· An authorized official is an appointed official (for example, chief executive officer, chief financial officer, general partner, chairman of the board or direct owner) to whom the organization has granted the legal authority to enroll it in the Medicare program, to make changes or updates to the organization's status in the Medicare program, and to commit the organization to fully abide by the statutes, regulations and program instructions of the Medicare program. · The authorized official may not be a "contracted" managing employee. Furthermore, an authorized official must be an authorized official of the provider, not of an owning organization, parent company or management company.

Slide 89

Section 15: Certification Statement (Cont.)

Delegated official:

· A delegated official is an individual who is delegated by an authorized official the authority to report changes and updates to the provider's enrollment record. A delegated official must be an individual with an ownership or control interest in, or be a W-2 managing employee of, the provider. · Delegated officials may not delegate their authority to any other individual. Only an authorized official may delegate the authority to make changes and/or updates to the provider's Medicare status. · The delegated official must be a delegated official of the provider, not of an owning organization, parent company or management company. Note: The delegated official has no authority to sign an initial enrollment application or a revalidation application. The primary function of a delegated official is to sign off on changes of information.

Slide 90

Section 15.A: Additional Requirements for Medicare Enrollment

Section 15A outlines an additional seven points of certification that deal directly with the protection of the Medicare program. Medicare applicants must attest that they have read, understand and will abide by these additional requirements.

Slide 91

Section 15.B: First Authorized Official Signature

The statement reads: "I have read the contents of this application. My signature legally and financially binds this provider to the laws, regulations and program instructions of the Medicare program. By my signature, I certify that the information contained herein is true, correct and complete, and I authorize the Medicare feefor-service contractor to verify this information. If I become aware that any information in this application is not true, correct or complete, I agree to notify the Medicare fee-for-service contractor of this fact immediately." If you are changing, adding or deleting information, check the applicable box, furnish the effective date and complete the appropriate fields in this section.

Slide 92

Section 15.B: First Authorized Official Signature (Cont.)

Slide 93

Section 15.C: Second Authorized Official Signature

The statement reads: "I have read the contents of this application. My signature legally and financially binds this provider to the laws, regulations and program instructions of the Medicare program. By my signature, I certify that the information contained herein is true, correct and complete, and I authorize the Medicare feefor-service contractor to verify this information. If I become aware that any information in this application is not true, correct or complete, I agree to notify the Medicare fee-for-service contractor of this fact immediately." If you are changing, adding or deleting information, check the applicable box, furnish the effective date and complete the appropriate fields in this section.

Slide 94

Section 15.C: Second Authorized Official Signature (Cont.)

Slide 95

Section 16: Delegated Official(s)

Providers are not required to have a delegated official. However, if no delegated official is assigned, the authorized official will be the only person who can make changes and/or updates to the provider's status in the Medicare program. The signature of a delegated official has the same force and effect as that of an authorized official, and legally and financially binds the provider to the laws, regulations and program instructions of the Medicare program. By his signature, the delegated official certifies that he has read the Certification Statement in Section 15 and agrees to adhere to all of the stated requirements.

Slide 96

Section 16: Delegated Official(s) (Cont.)

Delegated officials being deleted do not have to sign or date this application. The signature of an authorized official in Section 16 constitutes a legal delegation of authority to any and all delegated officials assigned in Section 16. If there are more than two individuals, copy and complete this section for each individual.

Slide 97

Section 16.A: First Delegated Official Signature

Slide 98

Section 16.B: Second Delegated Official Signature

Slide 99

Section 17: Supporting Documents

This section lists the documents that, if applicable, must be submitted with this completed enrollment application. If you are newly enrolling, reactivating or revalidating your enrollment, you must provide all applicable documents. For changes, only submit documents that are applicable to the change requested.

Slide 100

Section 17: Supporting Documents ­ Mandatory

Required documents that can only be obtained after a state survey are not required as part of the application submission but must be furnished within 30 days of the provider receiving them. The Medicare FFS contractor will furnish specific licensing requirements for your provider type upon request.

Slide 101

Section 17: Supporting Documents ­ Mandatory (Cont.)

Mandatory documents for all provider/supplier types include:

· Licenses, certifications and registrations required by Medicare or state law. · Federal, state and/or local (city/county) business licenses, certifications and/or registrations required to operate a health care facility. · Written confirmation from the IRS confirming your Tax Identification Number with the legal business name (e.g., IRS CP 575) provided in Section 2. · Completed Form CMS-588 (Authorization Agreement for Electronic Funds Transfer). Note: If a provider already receives payments electronically and is not making a change to its banking information, CMS-588 is not required. · Copy of the National Provider Identifier (NPI) notification that you received from the National Plan and Provider Enumeration System (NPPES).

Slide 102

Section 17: Supporting Documents ­ Mandatory if Applicable

Mandatory documents, if applicable, include:

· Copies of all bills of sale or sales agreements (change of ownership, acquisitions, mergers and consolidations only). · Statement in writing from the bank. If Medicare payment due a provider of services is being sent to a bank (or similar financial institution) where the provider has a lending relationship (that is, any type of loan), then the provider must provide a statement in writing from the bank (which must be in the loan agreement) that the bank has agreed to waive its right of offset for Medicare receivables.

Slide 103

Section 17: Supporting Documents ­ Mandatory if Applicable (Cont.)

· Copies of all adverse legal action documentation (e.g., notifications, resolutions and reinstatement letters). · Copy of the delegated official's W-2, if a delegated official has been designated. · Copy of an attestation for government entities and tribal organizations. · Copy of Health Resources and Services Administration (HRSA) Notice of Grant Award, if that is a qualifying document for Federally Qualified Health Center (FQHC) status.

Slide 104

Medicare Enrollment Application Privacy Act Statement

CMS is authorized to collect the information requested on this form by Sections 1124(a)(1), 1124A(a)(3), 1128, 1814, 1815, 1833(e) and 1842(r) of the Social Security Act (42 U.S.C. §§1320a-3(a)(1), 1320a-7, 1395f, 1395g, 1395(l)(e) and 1395u(r)), and Section 31001(1) of the Debt Collection Improvement Act (31 USC §7701(c)).

Slide 105

Enrolled Medicare Providers

The following actions apply to Medicare providers already enrolled in the program:

· · · · · · · Reactivation. Voluntary termination. Change of Ownership (CHOW). Acquisition/merger. Consolidation. Change of information. Revalidation.

Slide 106

CHOW

A CHOW typically occurs when a Medicare provider has been purchased (or leased) by another organization. The CHOW results in the transfer of the previous owner's identification number and provider agreement (including any Medicare outstanding debt of the previous owner) to the new owner. The regulatory citation for CHOWs can be found at 42 CFR 489.18. If the purchaser (or lessee) elects not to accept a transfer of the provider agreement, then the old agreement should be terminated and the purchaser or lessee is considered a new applicant.

Slide 107

CHOW (Cont.)

Slide 108

CHOW (Cont.)

Slide 109

CHOW (Cont.)

Slide 110

CHOW (Cont.)

Slide 111

Section 2.F: CHOW Information

Slide 112

Common Errors in Initial/CHOW/Acquisition/Merger

Common errors in the initial, CHOW, acquisition/ merger or consolidation information include:

· The NPI, Medicare Identification Number and Tax Identification Number are not reported in Section 1 (page 5). · The "Other Name" is not reported in Section 2.B.1 (page 8). · The license and certification information is left blank in Section 2.B.2 (page 9).

Slide 113

Common Errors in Initial/ CHOW/Acquisition/Merger (Cont.)

· The "Doing Business As" (DBA) name listed in Section 2.B.1 (page 8) does not agree with the practice location name listed in Section 4.A (page 17). · The last four digits of the ZIP code are not reported in the "ZIP Code + 4" field for the practice location address in Section 4.A (page 17). Also, the effective date is omitted. · The Tax Identification Number is left blank in Section 5.A (page 23) and Section 8 (page 30). Also, the effective date is omitted.

Slide 114

Common Errors in Initial/ CHOW/Acquisition/Merger (Cont.)

· The applicable boxes are not checked in Section 6.A indicating the individual's relationship with the provider (page 27). · Incorrect Social Security numbers and names are reported in Section 6 (page 27). · Section 6 (page 27) is not completed for the authorized and/or delegated officials listed in Sections 15 and 16. · The legal name is incorrect in Section 8 (page 30).

Slide 115

Common Errors in Initial/ CHOW/Acquisition/Merger (Cont.)

· E-mail address is omitted in Section 13 (page 33). · The "Yes" and "No" boxes throughout the application are not answered, especially in Sections 5.B (page 24) and 6.B (page 27). · The box indicating that the section is not applicable is not checked. · Section 17 (page 41) is not completed and/or submitted.

Slide 116

Common Errors in Change of Information

Common errors in the change of information include:

· Section 1 (page 5) is not submitted. · The NPI is not reported in Section 1.A (page 5). · Section 1.B (page 6) does not reflect all items being changed. · The "Other Name" is not reported and the "Type of Other Name" is not checked in Section 2.B.1 (page 8).

Slide 117

Common Errors in Change of Information (Cont.)

· The DBA name in Section 2.B.1 (page 8) does not agree with the practice location name in Section 4.A (page 17). · The date of accreditation is not included in Section 2.D (page 9). · The last four digits of the ZIP code are not reported in the "ZIP Code + 4" field for the practice location address in Section 4.A (page 17). · The telephone number is left blank in Section 4.A (page 17).

Slide 118

Common Errors in Change of Information (Cont.)

· The adverse legal history is left blank in Section 5.B (page 24) and Section 6.B (page 27). · The effective dates are omitted in Sections 4.A, 4.B, 5, 6, 15 and 16. · E-mail address is incorrect in Section 13 (page 33). · The "Yes" and "No" boxes throughout the application are not answered, especially in Sections 5.B and 6.B. · The box indicating that the section is not applicable is not checked. · Section 17 (page 41) is not completed and/or not submitted

Slide 119

Common Errors in Supporting Documentation

Common errors in supporting documentation include:

· IRS tax documentation is not submitted, or the IRS document submitted does not reflect the entire legal business name as reported on the 855A. · For governmental and tribal entities, the letter attesting that the government or tribal organization will be legally and financially responsible in the event that there is an outstanding debt owed to CMS is often omitted. Refer to page 22 (instruction page) of the CMS-885A.

Slide 120

Common Errors in Supporting Documentation (Cont.)

· For corporations (organization type listed in Section 2.B.1), the Articles of Incorporation are not submitted for initial enrollment, revalidations and changes requiring full CMS-855A applications.

Slide 121

EFT Requirement

For new enrollees, all payments must be made via Electronic Funds Transfer (EFT). A completed Form CMS-588 (EFT Authorization Agreement) must accompany the CMS-855A application when applying for Medicare certification. If an enrolled provider who currently receives paper checks submits a CMS-855 change, a CMS-588 must also be submitted. Note: Once a provider is established to receive payment via EFT, the provider must continue to receive payment using EFT.

Slide 122

Common EFT Error

In Part V of the CMS-588, the name of the FFS contractor is omitted or the wrong contractor name is reported.

Slide 123

General Processing Timelines

Initial applications (CHOWs, acquisitions, mergers and consolidations submitted by the new owner(s) and changes requiring full CMS855A applications):

· Up to 180 days to process the application.

Changes (including voluntary terminations):

· Up to 90 days to process the application.

Slide 124

Timeline Factors

Major factors that impact processing time:

· Completeness and accuracy of submitted application. · FI's pending inventory when application is received. Note: For initial enrollments and changes requiring CMS approval, the enrollment process continues beyond the FI's processing of the CMS-855A application.

Slide 125

Contact Information

Part A Provider Enrollment (866) 528-1603 Hours of operation: 8 a.m. ­ 4 p.m. CT Monday ­ Friday Note: Messages are retrieved and calls returned within two to three business days of receipt.

Slide 126

Contact Information (Cont.)

Mailing address:

TrailBlazer Health Enterprises, LLC Part A Provider Enrollment P.O. Box 650458 Dallas, TX 75265-0458

Overnight delivery address:

TrailBlazer Health Enterprises, LLC Part A Provider Enrollment Executive Center III 8330 LBJ Freeway Dallas, TX 75243

Note: Part A Provider Enrollment cannot address and/or resolve Part B/carrier enrollment issues. All carrier issues must be directed to the carrier.

Slide 127

Education Makes the Difference

Education Makes the Difference

Education Makes the Difference

Part A Fundamentals of Provider Enrollment

Thank you for attending.

Information

Part A Fundamentals of Provider Enrollment

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