Supplier standard #2 requires suppliers to notify the NSC of any change to the information provided on the CMS 855S within 30 days. Therefore, if you have added or stopped providing a specialty, product or service, moved to a new location, or made changes to your ownership you must notify the NSC. Failure to do so may result in the revocation of your billing privileges and/or overpayments.

Change in Products or Services
If a supplier is adding products or services that will be provided to a Medicare beneficiary state required licenses should be submitted along with the CMS 855S. This indicates compliance with state and federal regulations with regard to the new specialty, product or service (supplier standard #1).

Information as to what licenses are required is available under Licensure Information. The licensure information should only be used as a guide. Federal and state agencies have the final authority to determine what licenses are required. Suppliers are responsible for ensuring they have all the licenses required to operate their business.

Listed below are the common sections for making changes to a supplier file. 

Common Sections for all Changes of Information
Section 1B ' (Basic Information - Reason for submitting the CMS 855S)

• List the supplier number
• List the NPI
• Check 'You are changing your Medicare information'

Section 1C ' (Basic Information ' Type of Change)

• Check 'Identifying Information'

Section 2.A.1 ' (Identifying Information)

• As instructed, please complete this section in its entirety

Section 3 (Adverse Legal Actions/Convictions)
Please review the information in this section and check the appropriate box. Please do not leave this section blank. If the section does not apply, please check 'No'. If you need to report any actions, please check 'Yes' and provide the required information.

Section 13 ' (Contact Person)
Please list the name and contact information of an individual the NSC analyst may contact to obtain additional information or to obtain clarification

Section 15 - (Certification Statement) or 16 - (Delegated Official(s))
Signatures and dates must be original. If not original the CMS 855S will be returned.

See below the Change of Information guidelines for common changes to be made on the CMS-855S enrollment application.  These sections should be completed in addition to the sections completed for all changes of information. 

• Changes of Address
  • 2A1, 2A2 (Correspondence address), 2A3 ( Address to send re-enrollment packet)
• Changes In Ownership
  • 3, 5, &6
• Changes in Specialty/Products & Services
  • 2B, 2C, 2D
• Voluntary Termination
  • 1B & 4A
• Change of Legal Business Name
  • 2A1

Please note, in order to update the legal business name a copy of an official document from the IRS must be submitted verifying the name in Section 2A1. Examples of acceptable documents are available under the Helpful Hints for Completing the CMS 855S.

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