Provider Enrollment Functions Provider Enrollment is a critical function that attempts to ensure that only qualified and eligible individuals and entities are enrolled in the Medicare program and receive reimbursement for services furnished to beneficiaries. Since its conception in 1998, the CMS-855A Medicare Federal Health Care Provider/Supplier Enrollment Application is used for various reasons, ranging from Changes of Ownership to Changes of Information (address, telephone numbers, authorized official(s), etc.) The Centers for Medicare & Medicaid Services (CMS), along with Empire Medicare Services, believes that disclosing this information will ensure that the proper individuals or entities (providers) are enrolled and being reimbursed properly for the services that they are furnishing. The application timeframes vary according to the type of action that has taken place. For Initial Enrollments, Changes of Ownership, Mergers, and Consolidations, the Fiscal Intermediary (FI) has up to 60 days to process the application and then forward a recommendation to the applicable State Agency and CMS Regional Office. The State Agency and CMS do not have set time frames like the FI, and there are instances when this process could take up to a few months or more after the initial 60-day time period, depending on the circumstances and nature of the transaction. Changes of Information have a 45-day timeframe, and then they are forwarded to the State Agency and CMS (as applicable). Information regarding the Provider/Supplier Enrollment Application can be found in Pub 100-08, the Medicare Program Integrity Manual, Chapter 10. The CMS-855A Application Forms can be obtained online at www.cms.gov, Ted Kavanaugh Tania Mingolelli |
or by calling the Fiscal Intermediary. Any questions regarding the enrollment process or obtaining an application can be made to Ted Kavanaugh or Tania Mingolelli.
