Provider Enrollment Application: Frequently Asked Questions

How do I submit a Medicare enrollment application to Palmetto GBA?

Answer:
All institutional providers should complete the CMS Form 855A. The form can be submitted using the paper version of the form or via the Internet based Provider Enrollment Chain Ownership System (PECOS) online submission process. Here is a link to the paper version of the CMS Form 855A (PDF, 772 KB) form on the CMS website.  To access Internet-based PECOS, visit https://pecos.cms.hhs.gov/pecos/login.do on the CMS website.

The CMS-855A Medicare Enrollment Application states that the National Provider Identifier (NPI) must be submitted. My facility has not obtained the NPI yet. Can the form be submitted without this?

Answer:
CMS requires submission of a copy of the NPI documentation with the CMS-855A application. This can be obtained from the National Plan and Provider Enumeration System (NPPES). NPI information is accessible on the NPPES website. For questions on the NPI, contact the Enumerator at 800-465-3203 or TTY 800-692-2326. The NPI and Medicare identification number must also be identified in Section 4 of the CMS-855A application. The provider should obtain the NPI prior to submitting the CMS-855A application since it cannot be approved until the NPI requirement is met.

Note: The Legal Business Name as reported to the Internal Revenue Service should be reported to the NPPES Enumerator exactly as it appears on the IRS documentation.

The CMS-855A Medicare Enrollment Application states that the Electronic Funds Transfer (EFT) agreement must be submitted. Our organization does not want payments to be sent electronically. Will the application be accepted without this agreement?

Answer:
CMS requires that providers and suppliers, who are enrolling in the Medicare program or making a change in their enrollment data, receive payments via electronic funds transfer. Submission of the CMS-588 is mandatory. The CMS-588 must be signed by the authorized official that signed the Medicare enrollment application.

Note: If a provider or supplier already receives payments electronically and is not making a change to his/her banking information, the CMS-588 is not required.

If you are a supplier who is reassigning all of your benefits to a group, neither you nor the group is required to receive payments via electronic funds transfer.

How do I submit the enrollment application fee?

Answer:
Internet based PECOS On-Line Application Submitters:

For those who submit applications online via the PECOS website (also referred to as PECOS Provider Interface or PECOS PI), proceed through the Internet based PECOS application process. If a fee is required, you will be prompted to submit your payment by credit card or ACH debit card. Once your payment transaction is complete, you will be automatically returned to the PECOS website to complete the remaining part of your application. PECOS will track the collection transaction and will update payment status, allowing your application to be processed.

855 Paper Application Submitters:
For providers who continue to use the 855 paper enrollment application, you will now submit your application fee using the CMS website.

Complete the Medicare Application Fee form and click the ‘PAY NOW’ button. You will be redirected to enter and submit payment collection information. At the conclusion of the collection process, you will receive a receipt indicating the status of your payment. Please print a copy for your records. We strongly recommend that you attach this receipt to the completed CMS-855 application submitted to your Medicare contractor.

I am a Home Health Agency, how do I determine my Initial Reserve Operating Funds (IROF) or capitalization amount?

Answer:
Your capitalization amount is calculated by Palmetto GBA when the provider enrollment application is received. You will be notified of your capitalization amount after initial prescreening of the application. Ensure that Section 12 of the CMS-855A is completed accurately by your agency. The capitalization amount is based on factors such as, geographic location, urban/rural status, comparable home health agencies, and visits.

What is the process once Palmetto GBA receives my application?

Answer:
Palmetto GBA’s Provider Enrollment department will pre-screen the application for accuracy. A notification will be sent via email or fax if additional information or corrections are needed. The provider will have 14 days to respond to this letter, or the application will be rejected or denied. If the application contains all of the necessary information, an email is sent acknowledging receipt of the application.

Palmetto GBA has a minimum of 60 calendar days to process a paper application and 45 days to process an Internet PECOS submitted application. Once the application is processed, Palmetto GBA will send a letter to the provider indicating that the application has been approved, and forwarded to CMS and the state, if needed. There is no required timeframe for CMS to process the application; however this can take six to nine months.

Our facility has received notification from CMS that we are approved as a certified provider to participate in the Medicare program. What happens next?

Answer:
CMS makes notification to Palmetto GBA of all new certified provider approvals (called a tie-in notice). Upon receipt of the tie-in notice Palmetto GBA will update all necessary systems with your information. The processing time after receipt of the tie-in notice is approximately 21 days. A site visit is required for initial enrollments for HHA and Hospice providers. Therefore, the approval process can take approximately 30-45 days or longer from the date we receive the tie-in notice. Palmetto GBA will send written notification once all updates are complete.

Note: the Electronic Data Interchange (EDI) application should not be submitted until you have received notification that all systems updates are complete.

I am going through a Change of Ownership (CHOW); when will payments be made to the new owner?

Answer: 
After the CMS-855A process is complete, and CMS has issued the CMS-2007 tie-in notice documenting the approval of the change of ownership, Palmetto GBA can approve the updated information into PECOS. When PECOS is approved, the FISS system is updated from PECOS, within a few days. Once both of these systems are updated, the new owner can begin billing with their new NPI and begin receiving reimbursement for the provider.

What is an Audit Intermediary (AI)?

Answer:
The audit intermediary (AI) is the Medicare contractor assigned by the Centers for Medicare & Medicaid Services (CMS) that is responsible for reviewing and auditing the provider's Medicare cost reports to ensure compliance with the principles of Medicare reimbursement and determining final settlement of the cost report. The AI is also responsible for reviewing the CMS-855A application. This may be a different intermediary from the claim intermediary, which processes and pays your Medicare claims. For most providers, the AI and claims intermediary are the same. However, provider-based entities may have different AI and claims intermediaries.

If you are provider-based and need to identify your audit intermediary, refer to the CMS website (PDF, 123 KB), and look for the Fiscal Intermediary for your state.

What is revalidation?

Answer:
Revalidation is validation that all Medicare information on file is accurate and up to date. All providers who enrolled with Medicare prior to March 25, 2011, are required to revalidate their Medicare enrollment by submitting the appropriate CMS-855 Medicare enrollment form(s) to their Medicare contractor in response to notices sent between September, 2011, and March, 2015. This requirement for revalidation is based on Section 6401 of the Patient Protection and Affordable Care Act., which also requires that all providers be reevaluated under the screening guidelines established in Section 6028 of the law.

Do I need to revalidate my Medicare Information?

Answer:
Change Request 7350 and Special Edition (SE) 1126 provide instructions on the revalidation process. SE1126 reminds providers that providers must revalidate their enrollment only after receiving notification from their Medicare Administrative Contractor (MAC). Once you receive notification from Palmetto GBA, you will need to update your enrollment through PECOS or by completing the CMS-855A, signing the certification statement on the application and paying any applicable fees through the CMS website. Mail your supporting documents, a copy of the revalidation letter and the certification statement to Palmetto GBA. Providers must use the e-signature process or upload the certification statement via PECOS upload functionality, because contractors can no longer accept mailed paper certification statements, per Change Request 10845. Also, ensure that you attach your payment confirmation with your documentation.

How do I know when to expect my revalidation letter?

Answer: 
You will receive a letter in a yellow envelope, it will be posted on www.CMS.gov, and it will be listed on your enrollment in PECOS.

What do I need to do to receive an extension, and what reasons are approved?

Answer: 
Call Palmetto GBA to request an extension.

How much time do I have to respond to the revalidation request?

Answer: 
Providers have 60 days from the date of the revalidation notice to submit their complete enrollment information. Providers are to submit their CMS-855 revalidation enrollment applications only after receiving notification that they are required to do so.

What address are the revalidation letters mailed to?

Answer: 
Revalidation letters are sent to the special payment and correspondence address. If both of these addresses are the same, the letter will be sent to the primary practice location address. If all addresses are the same only one letter will be sent.

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