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Last Modified: 8/15/2022 Location: FL, PR, USVI Business: Part A, Part B

Top provider enrollment development reasons

Want to learn how to avoid the top reasons that may delay the processing of your enrollment application? First Coast will send development letters to you when we need additional information, documents, or updated application sections to complete the processing of the application. You have 30 days to reply to a development letter with the requested information to prevent what from happening?
Before you submit your application, make sure you review how to prevent these top mistakes to prevent delays.
Part A paper applications

Reason for development
How to prevent development
Incomplete or missing section 3
Final adverse legal actions are reported in section 3. The information that should be reported includes convictions, exclusions, and suspensions. If you’re unsure if the information should be reported or not, go ahead and report it.
Incomplete or missing section 5 or 6
In the CMS-855A, Ownership interest and/or managing control information is submitted in section 5 (organization) or section 6 (individuals). All owners, board of directors, and managing employees must be reported.
Typo in existing PTAN, NPI, legal business name, or other information
Double check all application information to ensure the correct, valid information is submitted.
Missing signature or date in Section 15 or 16
An application must be signed by a valid, current individual on file. Make sure the signature page is filled out in full, including signature date.
Incomplete or inaccurate supporting document: Voided check or bank letter or Exhibit 177
A signed and dated Exhibit 177 external pdf file is required for all newly enrolling federally qualified health centers (FQHCs).
Part A PECOS applications

Reason for development
How to prevent development
Incomplete or missing Section 5 or 6
In the CMS-855A, ownership interest and/or managing control information is submitted in section 5 (organization) or section 6 (individuals). All owners, board of directors, and managing employees must be reported.
Certification not e-signed or paper certification not uploaded
An application must be signed by a valid, current individual on file. Make sure the certification statement is filled out in full, including signature date. If you select paper certification statements for PECOS applications, you must upload it to PECOS. The paper certification statement for PECOS applications can’t be mailed.
Authorized or delegated official is not eligible
Authorized officials are appointed officials to whom the organization has granted the legal authority to enroll it in the Medicare program, to make changes or updates to the organization's status in the Medicare program, and to commit the organization to fully abide by the statutes, regulations, and program instructions of the Medicare program.
Delegated officials are individuals who are delegated by the “authorized official” the authority to report changes and updates to the provider/supplier’s enrollment record. The delegated official must be an individual with an ownership or control interest in, or be a W-2 managing employee of, the provider or supplier.
All authorized and delegated officials must meet all requirements, be added for the organization, and sign the applicable applications.
Application fee (when required)
Institutional providers that are initially enrolling, adding a practice location, or revalidating must submit with the application an application fee or hardship exception to the application fee.
Incomplete or inaccurate supporting document: Voided check or bank letter or Exhibit 177
A signed and dated Exhibit 177 external pdf file is required for all newly enrolling FQHCs.
Part B paper applications

Reason for development
How to prevent development
Incomplete or missing Section 3
Final adverse legal actions are reported in section 3. The information that should be reported includes convictions, exclusions, and suspensions. If you’re unsure if the information should be reported or not, go ahead and report it.
Incomplete or missing Section 4
Organization and address information are reported in section 4 of the CMS-855B and CMS855I. Review the entire section for completeness. All applicable sections must be completed.
Incomplete or missing section 5 or 6
In the CMS-855B, ownership interest and/or managing control information is submitted in section 5 (organization) or section 6 (individuals). In the CMS-855I, managing employee information is submitted in section 6. All owners, board of directors, and managing employees must be reported.
Dependent application not submitted
In certain circumstances, a dependent application is required. Please see below for common scenarios:
Initial enrollment with reassignment: CMS-855I and CMS-855R
Initial enrollment of clinic or group practice: CMS-855B and CMS-855R (or CMS-855I for Physician Assistant)
Initial enrollment of group or organization: corresponding CMS-855 and CMS-588
Incomplete or missing CMS-588 EFT or supporting documentation for EFT
The CMS-588 form must be submitted to establish electronic funds transfer. Verification must be submitted with the CMS-588 form, which can be a voided check or signed bank letterhead.
Part B PECOS applications

Reason for development
How to prevent development
Incomplete or missing Section 4
Organization and address information are reported in section 4 of the CMS-855B and CMS855I. Review the entire section for completeness. All applicable sections must be completed.
Incomplete or missing Section 5 or 6
In the CMS-855B, Ownership interest and/or managing control information is submitted in section 5 (organization) or section 6 (individuals). In the CMS-855I, managing employee information is submitted in section 6. All owners, board of directors, and managing employees must be reported.
Certification not e-signed or paper certification not uploaded
An application must be signed by a valid, current individual on file. Make sure the certification statement is filled out in full, including signature date. If you select paper certification statement for PECOS applications, you must upload it to PECOS. The paper certification statement for PECOS applications can’t be mailed.
Authorized or delegated is not eligible
Authorized officials are appointed officials to whom the organization has granted the legal authority to enroll it in the Medicare program, to make changes or updates to the organization's status in the Medicare program, and to commit the organization to fully abide by the statutes, regulations, and program instructions of the Medicare program.
Delegated officials are individuals who are delegated by the “authorized official” the authority to report changes and updates to the provider/supplier’s enrollment record. The delegated official must be an individual with an ownership or control interest in, or be a W-2 managing employee of, the provider or supplier.
All authorized and delegated officials must meet all requirements, be added for the organization, and sign the applicable applications.
Incomplete or missing CMS-588 EFT or supporting documentation for EFT
The CMS-588 form must be submitted to establish electronic funds transfer. Verification must be submitted with the CMS-588 form, which can be a voided check or signed bank letterhead.

View our provider enrollment videos on First Coast’s YouTube channel

Make sure you check out our provider enrollment playlist on our YouTube channel, YouTube.com/FirstCoastServiceOptions external link. Our videos answer top provider enrollment questions and gives tips for avoiding common errors.
Let us know if you enjoyed the videos by selecting the Like button or taking our survey available in each video description.
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.