Listed below are the 5 most common reasons a Provider Enrollment
application process is delayed.
Section 7 of the CMS 855R is not signed or is not signed by the
appropriate official.
Section 7 must be signed by an authorized
official to whom the organization has granted the legal authority to
enroll it in the Medicare program, to make changes and/or updates to
the organization status in the Medicare program, and to commit the
organization to fully abide by the laws, regulations, and program
instructions of Medicare. The authorized official must be the
organizations general partner, chairman of the board, chief
financial officer, chief executive officer, or president, or must
hold a position of similar status and authority within the
organization. This person also must have been listed in section 6 of
the CMS 855B application
Requesting a completed CMS 855B application.
A CMS 855B
application must be completed by all organizations that will be
billing Medicare carriers for medical services furnished to Medicare
Beneficiaries. This form must also be completed if a tax id number
has changed for an established organization. CMS 855R’s are being
received requesting reassignment of benefits back to an organization
that has not completed a CMS 855B application for the organization.
Section 6 of the CMS 855B application is not completed.
Section 6 of the CMS 855B application requests information on
individuals that have ownership interest and/or managing control
in the enrolling organization. All fields of this section must
be completed for each individual that is listed.
Requesting a completed CMS 855I application
. A CMS 855I
application must be completed by physicians and non-physician
practitioners who renders medical services to Medicare
beneficiaries. Physician or non-physician practitioners that are
enrolling in the Medicare program for the first time, are currently
enrolled with a carrier but need to enroll in another carriers
jurisdiction, or are needing to reactivate billing privileges due to
prior deactivation for non-billing, must complete the CMS 855I
application. CMS 855R’s are being received when the physician or
non-physician practitioner is not currently enrolled in the Medicare
program in this jurisdiction.
Requesting a CP575.
A CP575 must be submitted with the CMS
855I and the CMS 855B application anytime a tax id number is used.
The CP575 is the official letter from the IRS confirming the tax
identification number with the legal business name. If the CP575 is
not available, we will also accept a copy of the quarterly tax
payment coupon or any official letter from the IRS that lists the
legal business name and tax id number.
