The Centers for Medicare and Medicaid Services (CMS) recently made some changes to how the NSC will develop for data elements missing from the CMS 855S or information that needs clarification.
The National Supplier Clearinghouse (NSC) processes durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) enrollment documentation following Medicare guidelines and regulations published in the Code of Federal Regulation (CFR) and the Medicare Program Integrity Manual (PIM).
Pub 100-8, Chapter 10, Section 3 of the PIM and 42 CFR 424.525 provide instruction on the application pre-screening and rejection processes.
Below are the changes that effect DMEPOS enrollment:
Pre-screening
Verifies if all data elements completed and all required documentation submitted. If any information is missing:
- Suppliers will be notified via e-mail or fax
- This will be the only request made
- Suppliers will have 60 days from date of notification to return all required information
Rejection
Information received must be accurate and complete.
- The NSC is not required to contact supplier again to request information. Therefore it is imperative that all information be accurate and complete.
- If additional requests are made based on the suppliers inquiry or site visit results, information must be submitted within the initial 60 days
- Good faith effort. If supplier is making a concerted effort, the NSC may continue to process the enrollment documentation.
Application will be closed if information not received within 60-day timeframe and:
- Suppliers will be required to resubmit
- Suppliers are not able to appeal this decision
Helpful Hints
- Review enrollment documentation prior to submission to ensure all information is accurate and complete and that all required documentation is included
- Utilize the helpful hints and check lists available on the NSC Web site
- Make sure to retain your fax confirmation indicating the requested information was successfully transmitted to the NSC
- Ensure the response is addressed to a specific analyst. Many times responses are received, but addressed to the NSC and not to the analysts processing the documentation