Last Modified: 3/29/2024
Location: FL, PR, USVI
Business: Part A, Part B
We’re required to immediately return an application if any of the following conditions exist:
• The provider/supplier sent its paper form CMS-855 form CMS-588, or form CMS-20134 to the incorrect contractor for processing (e.g., the application was sent to contractor X instead of contractor Y).
• The contractor received the application more than 60 days prior to the effective date listed on the application.
• This does not apply to initial form CMS-855A applications and ambulatory surgical centers and portable x-ray suppliers submitting an initial form CMS-855A application.
• The seller or buyer in a CHOW submitted its form CMS-855A or form CMS-855B more than 90 days prior to the anticipated date of sale.
• The contractor received an initial application more than 180 days prior to the effective date listed on an application from an ambulatory surgical center, a portable x-ray supplier, or a provider/supplier submitting a form CMS-855A application.
• The contractor confirms that the provider/supplier submitted an initial enrollment application prior to the expiration of the time period in which it is entitled to appeal the denial of its previously submitted application.
• The provider or supplier submitted an initial application prior to the expiration of their existing re-enrollment bar or reapplication bar.
• The application is not needed for the transaction in question. Two common examples include:
• A rebuttal decision has been issued (therefore, the submitted form CMS-855, form CMS-588, or form CMS-20134 is not needed.
• The provider or supplier submitted a revalidation application more than seven months prior to their revalidation due date.
• The Medicare diabetes prevention program supplier submitted an application with a coach start date more than 30 days in the future.
• A provider/supplier requests that their application be withdrawn prior to or during processing.
• A provider/supplier submits an application that is an exact duplicate of an application that has already been processed or is currently being processed or is pending processing.
• A provider or supplier submits a paper form CMS-855 or CMS-20134 enrollment application that is outdated or has been superseded by a revised version.
• The provider/supplier submits a form CMS-855A or form CMS-855B initial application followed by a form CMS-855A or form CMS-855B change of ownership application:
• Has not yet made a recommendation for approval concerning the initial application, both applications may be returned.
• Has made a recommendation for approval concerning the initial application, the Medicare contractor may return the change of ownership application. If, per the Medicare contractor's written request, the provider or supplier fails to submit a new initial form CMS-855A or form CMS-855B application containing the new owner's information within 30 days of the date of the letter, the Medicare contractor may return the originally submitted initial form CMS-855A or form CMS-855B application.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
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