When there is a change in your practice or facility that affects your credentialing information on file with Palmetto GBA, it is important that you submit updated information. Use this checklist to ensure that your changes are submitted on time.

These timeframes apply to:

  • Physicians
  • Non-physician practitioners
  • Physician and non-physician practitioner organizations
  • Independent Diagnostic Testing Facilities (IDTFs)

What
When
Change of ownership or control
Within 30 days of the change
Change in practice location
Within 30 days of the change
Final adverse action
Within 30 days of the change
All other changes
Within 90 days of the change

Submit changes by completing the appropriate sections of the CMS-855 application, using Internet PECOS or a paper application:

  • Changes for individual providers: submit an updated CMS-855I application
  • Changes for sole-owned groups: submit an updated CMS-855I application
  • Changes for provider groups: submit an updated CMS-855B application
  • Changes in reassignment of individual provider payments to a provider group: submit an updated CMS-855R application
  • IDTFs: submit an updated CMS-855B application

References:

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department



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