Change of Information

Providers are required to use the CMS 855A Provider/Supplier Enrollment Application for notifying Medicare of changes of information. The use of the application for updating provider information offers a standardized way to collect information from providers, but more importantly it offers a mechanism to ensure that only authorized representatives of the provider are requesting changes. Providers must notify the Medicare contractor of any changes to the information contained in this application within 90 days of the effective date of the change.

All provider changes must be signed by the authorized representative or a delegated official for the facility. The authorized representative is an appointed official to whom the provider has granted the legal authority to enroll it in the Medicare program, to make changes and/or updates to the provider's status in the Medicare program, and to commit the provider to fully abide by the laws, regulations, and program instructions of Medicare. The authorized official must be the provider's general partner, chairman of the board, chief financial officer, chief executive officer, president, or direct owner of five percent or more of the provider.

The authorized representative can delegate up to three delegated officials. The delegated official must be a W-2 managing employee of the provider, or an individual with five percent or more ownership interest in the provider.

Medicare began using the CMS 855A (or its predecessor the HCFA 855) to enroll providers in October 1997. Providers certified prior to October 1997 would not have an application on file, unless the provider has gone through a change of ownership since October 1997. Therefore, when changes are being submitted for the first time, the authorized representative must also complete section 6 of the application. When changes are made to the provider's application/profile, the signature certifying the change will be compared to the signatures listed on the most current application on file. The requirement of signature verification is for the protection of both the provider and the Medicare Trust Fund. By collecting the required information on the CMS 855A, CMS has an assurance that the appropriate personnel are requesting the change of information.

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