CMS-855 enrollment application processing timeframes

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Home ► PE Applications and forms ► CMS-855 enrollment application processing timeframes

Last Modified: 4/10/2024 Location: FL, PR, USVI Business: Part A, Part B

CMS-855 enrollment application processing timeframes

We encourage you to carefully read the instructions on your application for enrollment or changes of information and are sure to enclose any required documents with your submission. Failure to include needed information on the application, or failure to respond in a timely manner when additional information is requested, may result in your application being returned or increase processing delays. This measure will ensure timely processing of submission.

CMS has defined the following timeframes for processing CMS-855 forms:

Paper applications

Initial enrollments, change of information and opt-out affidavits:

• Require a site visit, development and/or fingerprinting:

• 95% completed within 65 calendar days of receipt

• 100% completed within 100 calendar days of receipt

• Do not require a site visit, development and/or fingerprinting:

• 95% completed within 30 calendar days of receipt

• 100% completed within 65 calendar days of receipt

Revalidation:

• Require a site visit, development and/or fingerprinting:

• 80% completed within 65 calendar days of receipt

• 100% completed within 100 calendar days of receipt

• Do not require a site visit, development and/or fingerprinting:

• 80% completed within 30 calendar days of receipt

• 100% completed within 65 calendar days of receipt

Internet-based PECOS applications

Initial enrollment and change of information:

• Require a site visit, development and/or fingerprinting:

• 95% completed within 50 calendar days of receipt

• 100% completed within 85 calendar days of receipt

• Do not require a site visit, development and/or fingerprinting:

• 95% completed within 15 calendar days of receipt

• 100% completed within 50 calendar days of receipt

Revalidation:

• Require a site visit, development and/or fingerprinting:

• 80% completed within 50 calendar days of receipt

• 100% completed within 85 calendar days of receipt

• Do not require a site visit, development and/or fingerprints:

• 80% completed within 15 calendar days of receipt

• 100% completed within 50 calendar days of receipt

To avoid delays, make sure all sections of the enrollment applications are completed and any supporting documentation is provided.

Initial enrollments include:

• CMS-855I applications submitted to enroll in Medicare for the first time; revalidation of enrollment information or reactivation of Medicare billing privileges.

• CMS-855B applications submitted to enroll in Medicare for the first time; revalidation of enrollment information or reactivation of Medicare billing privileges.

Part A certified providers:

• CMS-855A applications submitted to enroll in Medicare for the first time.

• Change of ownership (CHOW) / acquisition / merger / consolidation applications submitted by the new owner (buyer).

• CMS may take an additional 6-9 months to make the final determination over and above the contractor’s prescribed processing timeframes.

Change requests include:

• CMS-588 (EFT authorization agreement form) changes submitted without a need for an accompanying complete CMS-855 application;

• CMS-855 voluntary terminations;

• CMS-855I applications submitted to change information for a provider already registered in PECOS;

• CMS-855B applications submitted to change information for a group, ambulatory surgical center, or portable X-ray supplier already registered in PECOS.

Part A certified providers:

• CMS-855A applications submitted to change information for a provider already in PECOS

• CHOW / acquisition / merger / consolidation applications submitted by the old owner (seller).

Clock stoppages:

The processing timeliness clock temporarily stops when certain situations occur:

• Referring an application to the Office of Inspector General (OIG) or the Unified Program Integrity Contractor (UPIC).

• Waiting for a final sales agreement (e.g., CHOW, acquisition/merger).

• Contacting the CMS Location and/or State Agency (SA) regarding a provider-based or CHOW determination or the CMS Location's survey and certification staff with a question regarding the application of a CMS policy.

• Referring a provider or supplier to update their information in the National Plan & Provider Enumeration System.

• Contacting CMS' Provider Enrollment & Oversight Group (PEOG) for the following reasons: questions regarding the application, a CMS policy, an adverse legal action review, affiliations/overpayments found on the monthly report or PECOS, Advanced Provider Screening criminal alerts, or delayed site visits.

• Referring a provider to the Social Security Administration to resolve a discrepancy involving a social security number or to the Internal Revenue Service to resolve a Tax Identification Number or Individual Tax Identification Number issue.

• Contacting another Medicare Administrative Contractor (MAC) for any type of PECOS update (i.e.: locked associates).

• Contacting the PECOS Maintainer for resolutions to system issues (i.e.: RightNow tickets).

• Contacting the state licensing board to verify a license or to obtain board order documentation.

• Practice location and special payment address changes and specialty changes with future dates.

• If fingerprints are required, the timeliness clock stops when the fingerprint request is issued and resumes when we receive the results (if additional information is developed at the same time as the fingerprint request is issued, no action shall be taken on the developed information until after the fingerprint results are received).

• Situations can arise where the provider/supplier submits an Internet-based PECOS application and makes edits to it before all signatures are received. This can lock the PECOS Logging and Tracking (L&T), thus preventing the contractor from beginning to process the application until the application is resubmitted. The contractor in this specific situation may apply a clock stoppage between the time the L & T is locked and the time it is unlocked (i.e., the application is submitted). (Note that this instruction may be rendered moot with the implementation of PECOS 2.0.)

Should a dependent application be needed to continue processing, we will apply a clock stoppage when the development is issued and resume the timeliness clock once the development is received.

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