Did You Know? – Provider Enrollment
Click on an item to expand or Show All / Close All
- How do I access to the Internet-based Provider Enrollment, Chain and Ownership System (PECOS)?
-
To access Internet-based PECOS, visit https://pecos.cms.hhs.gov/pecos/login.do
on the CMS website.Reviewed 09/22/2021
-
- Who do I call if I have problems accessing the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) even though I have a PECOS User ID and password?
-
You will need to contact the Centers for Medicare & Medicaid Services (CMS) External User Services (EUS) Help Desk at 1-866-484-8049.
Reviewed 09/22/2021
-
- The CMS-855A Medicare Enrollment Application states that the National Provider Identifier (NPI) must be submitted. Our organization has not yet obtained the NPI. Can the form be submitted without this?
-
The provider should obtain the NPI prior to submitting the CMS-855A application since it cannot be approved until the NPI requirement is met. The NPI and Medicare identification number must also be identified in Section 4 of the CMS-855A application. NPI information is accessible on the NPPES website
. For questions on the NPI, contact the Enumerator at 800-465-3203 or TTY 800-692-2326.Reviewed 09/22/2021
-
- The CMS-855A Medicare Enrollment Application states that the Electronic Funds Transfer (EFT) agreement must be submitted. Our organization does not want payments to be sent electronically. Will the application be accepted without this agreement?
-
A completed Form CMS-588, Authorization Agreement for EFT, is mandatory with the submission of the CMS-855A enrollment application. The provider must submit this form with the application. The application cannot be approved if the EFT requirement is not met. If the provider is receiving Medicare payments electronically, and is not making a change to its banking information, the CMS-588 is not required. Note that if the provider does not have a prior approved CMS-855 application on file, and needs to submit an EFT form and/or make a special payments change in Section 4B, the entire application is required to be completed. Refer to the Enrollment Applications information on the CMS website for the EFT form
.Reviewed 09/22/2021
-
- How do I know what sections of the CMS-855A I need to complete?
-
The CMS-855A includes tables in Sections 1A and 1B that help you determine which sections of the application you need to complete. In addition, CGS offers the Part A Provider Enrollment Interactive Help Tool that is designed to walk you through the application process simply by asking you a series of questions.
Reviewed 09/22/2021
-
- What is the process when my enrollment application has been received by CGS?
-
You will receive an acknowledgement letter with a CGS Reference # via e-mail or mail. CGS's Provider Enrollment department will pre-screen the application to ensure it contains all of the necessary information. If additional information is needed, a letter is sent to the provider, via e-mail or mail, to indicate what information is needed. The provider will have 30 days to respond to this letter, or the application will be rejected. If the application contains all of the necessary information, no communication is sent to the provider. CGS has 60 calendar days to process a paper application, 45 days to process a web based application. Once the application is processed, CGS will send a letter to the provider indicating that the application has been processed, and forwarded to CMS and the state, if needed. Please note that if the application requires CMS approval, there is no required timeframe for CMS to process the application; however this can take 6-9 months.
Reviewed 09/22/2021
-
- We are uncertain whether our situation is a change of ownership or reorganization. How can we obtain assistance in determining this?
-
The CMS Regional Office (RO) makes the determination of whether a particular circumstance constitutes, for Medicare purposes, a change of ownership or a reorganization. Prior to submitting the CMS-855A, contact your CMS RO where your facility is located. To obtain the appropriate RO's address and/or phone number, refer to the CMS Contacts Database
on CMS's website, and use the search options below.- Select a State/Territory, select a State or "All States"
- Select a Contact Type, select "All Contact Types"
- Select an Organization Type, select "CMS RO – Centers for Medicare & Medicaid Services Regional Office"
Click Show Contacts to display the list of regional offices based on your selection. Click on the "General Professional Contact" link to display details.
Reviewed 09/22/2021
-
- When going through a change of ownership, when does Medicare begin making payment to the new owner?
-
After the CMS-855A process is complete, and CMS has issued the CMS-2007 tie-in notice documenting the approval of the change of ownership, CGS can approve the updated information into PECOS. For some situations, a site visit is required before a record can be approved. This process can take anywhere from 15-45 days or longer from when CGS receives the tie-in notice from CMS. When PECOS is approved, the FISS system is updated from PECOS, within a few days. Once both of these systems are updated, the new owner can begin billing with their new NPI and begin receiving reimbursement for the provider.
Reviewed 09/22/2021
-
- I received notification from CMS that I have been approved as a Medicare certified provider. How is CGS notified of this?
-
CGS will receive notification (called a tie-in notice) from CMS. Many times, providers will receive notification before CGS receives the tie-in notice. Once CGS receives the tie-in notice, we will update the necessary systems with your information. A site visit is required for initial enrollments for HHA, Hospice CORF and CMHC providers. Therefore, the approval process can take approximately 30-45 days or longer from the date we receive the tie-in notice.
Reviewed 09/22/2021
-
- Is the revalidation of provider enrollment an annual event that we need to do?
-
Providers will be required to revalidate their information every 5 years. However, providers should continue to report normal changes as needed. Changes such as changes in ownership or control, including changes in authorized official(s) or delegated official(s) must be reported to the Medicare fee-for-service contractor on the Medicare enrollment application within 30 calendar days of the change. All other changes to the enrollment application must be reported within 90 days.
Reviewed 09/22/2021
-
- We've completed the CMS-855A form, had our survey, and are waiting to be approved as a Medicare provider. What is delaying our approval?
-
The Centers for Medicare & Medicaid Services (CMS) revised Medicare provider enrollment guidelines to require a site visit prior to approving an enrollment application for agencies initially applying for Medicare certification. The site visits are completed by a national site visit contractor. CGS is unable to complete the enrollment process for agencies until we receive the site visit information from the national site visit contractor. CMS has provided additional information on the site visits
on their website.Reviewed 09/22/2021
-
- How do we terminate our Medicare provider number? How long does it take to terminate?
-
In order to terminate your Medicare provider number, you will need to complete the CMS-855A form
- Section 1A: select "You are voluntarily terminating your Medicare Enrollment," and enter the "Effective Date of Termination," "Medicare Identification Number" and "National Provider Identifier."In addition, you will need to complete Section 2B1, 13 and either 15 or 16 for authorized/delegated officials.
Standard application timeframes will apply for processing- 45 calendar days for electronic submission/60 calendar days for hard copy submission.
For assistance with completing the CMS-855A form, refer to the Part A Provider Enrollment Interactive Help Tool. This tool is designed to walk you through the application process simply by asking you a series of questions.
Reviewed 09/22/2021
-
- What is my capitalization amount?
-
Your capitalization amount is calculated by CGS Administrators, LLC, when the provider enrollment application is received. If Section 12 of the CMS-855A is completed accurately by your agency, the capitalization amount will be provided in the prescreen letter from CGS. The capitalization amount is based on factors such as, geographic location, urban/rural status, comparable home health agencies, and visits.
Reviewed 09/22/2021
-
- How do we submit the enrollment fee?
-
If you are using a paper CMS-855A form, access the website at https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do
and attach a copy of the payment receipt. If you are using internet-based PECOS to submit your CMS-855A, the fee is paid as part of the process when completing the application, and the payment status is updated automatically.Reviewed 09/22/2021
-
- When a provider mails in their CMS 855A and CGS approves the application, how long is it before it is forwarded to the Regional Office (RO) and is there a due date until the application expires?
-
Typically, initial & COI applications, paper based CMS-855A applications are processed within 30 calendar days of receipt. Web based applications are generally processed within 15 calendar days of receipt. Development for corrections, site visits, fingerprints (if required) as well as outreach outside the contractor may extend these time frames. CGS approves the initial enrollment application, our recommendation is valid for six months; however, if the State Survey process is delayed due to the provider not being ready, the recommendation is no longer valid. For additional information refer to the Provider Enrollment Review Process Web page on the CGS website.
Reviewed 09/22/2021
-
- If the application expires, do we need to pay the fee again?
-
No, for initial enrollment applications you do not need to pay another fee. CGS will re-certify the initial application again.
Reviewed 09/22/2021
-
- If we are adding a branch to our office, do we complete an 855A or do we contact the state?
-
An 855A is required to be completed when adding a branch office. Once CGS completes the review of the submitted 855A, CGS will make a recommendation to the state, who will make the final determination. We suggest contacting the state prior to submitting the 855A if you are unsure of the branch requirements. An application fee would be required for this type of change. Refer to the Medicare Application Fee
information on the CMS website.Reviewed 09/22/2021
-
- If we are adding a branch, what do we indicate in Section 1 for the change?
-
Select the "You are changing your Medicare information" box in Section 1. In Section 4, select "Add" and enter the effective date that the agency will be operational. The application should not be submitted until the branch office is open and operational as that is part of our review. An application fee would be required for this type of change. Refer to the Medicare Application Fee
information on the CMS website.Reviewed 09/22/2021
-
- Our 'parent' company is in Ohio and we now want to open a branch in West Virginia. Do we go through CGS for the branch office in West Virginia, or would we go through the parent company's Medicare contractor, which is Ohio?
-
A home health agency can only have a branch in another state (and treat it as a branch, rather than a separate HHA) if there is a reciprocity agreement between the two states. If none exists, the out-of-state location must enroll as a new provider by submitting a new Form CMS-855A and signing a separate provider agreement. It cannot be treated as a branch/practice location of the main HHA. (See Pub. 100-07, chapter 2, section 2184
for specific provisions regarding HHAs that cross State lines.)Reviewed 09/22/2021
-
- If we correct our address in PECOS, do we still need to complete an 855A form for the change of address? Do we need to notify CGS of the address correction in PECOS?
-
No, when you update your address in PECOS and submit the change, you are essentially submitting a web-based 855A application. CGS is then notified that an application needs to be processed.
Reviewed 09/22/2021
-
- Should we use PECOS to make updates, or do we need to send a paper 855A form?
-
Using PECOS is the CMS recommended method; however, you will need to request access to PECOS. Using PECOS allows you to see the same information the MAC sees in PECOS. Refer to theInternet-based PECOS page on the CMS website for more information about PECOS.
Reviewed 09/22/2021
-
- Why are Provider Enrollment fee payments not accepted?
-
Providers that submit enrollment information via the CMS-855A and are newly-enrolling, re-enrolling/re-validating, or adding a new practice location must pay an enrollment fee to the Centers for Medicare & Medicaid Services (CMS). Often, the provider enrollment application fee cannot be accepted due to errors made when completing the enrollment application fee information. The application fee payment is made by going to https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do
on the CMS website. The following identifies common errors seen by CGS. Please have your appropriate staff review this information.Note:When making your payment, ensure the following information is reported correctly, and matches the information reported on the enrollment application for which payment is being made.
- Amount paid is incorrect. Please be aware that the above website identifies the fee amount and year.
- Incorrect Tax Identification Information. Ensure the tax identification number (TIN) entered for payment, matches the TIN reported in Section 2B1 of the CMS-855A. The TIN number and the legal business name (LBN) should match your IRS-CP575 form.
- Incorrect provider type is selected. When submitting the CMS-855A enrollment application, select Part A Provider Services button, and ensure you select your correct provider type from the drop down menu.
- FFS Contractor. If CGS is not listed under the Fee For Service (FFS) contractor drop down menu, choose whatever option is available. Your fee payment will still be accepted even if the incorrect FFS contractor is selected.
For additional information, refer to the Medicare Application Fee webpage
on the CMS website.Reviewed 09/22/2021
-
- Does a new 855A need to be completed if a home health agency changes administrators?
-
Any time there is a change in a managing employee (i.e., administrator) a new 855A must be completed. The CMS-855A Medicare enrollment application must be completed when enrollment information needs to be added, deleted, or changed. This includes:
- Changing Existing Medicare Information - Currently Enrolled Providers
- Additions, Deletions, and Changes of Address
- Managing/Directing Employee Change
- Authorized/Delegated Official Change
- Transfer of Stock
- Note that in conjunction with any change submitted on the CMS-855A or 588 form, a full CMS-855A may be required if the provider has not submitted an application since implementation of the Provider Enrollment Chain and Ownership System (PECOS) on July 29, 2002
- Initial Enrollment Resulting in Issuance of a Medicare Provider Number
- Voluntary Termination
- Changes of Ownership (old and new owner)
- Acquisitions and Mergers (acquiring and acquired owners)
- Consolidations (consolidating owners and newly created provider)
- Revalidation
- Reactivation of previously deactivated provider number
For assistance with completing the CMS-855A form, refer to the Home Health & Hospice Provider Enrollment Interactive Help Tool. This tool is designed to walk you through the application process simply by asking you a series of questions.
Reviewed 09/22/2021 - Changing Existing Medicare Information - Currently Enrolled Providers
-
- I am a home health aide and I want to become Medicare certified. What steps do I need to take?
-
To begin the Medicare enrollment process, please contact the State Surveyor's office located in your state for licensing guidelines. For contact information, refer to the State Survey Agency Directory – January 2017
document.Reviewed 09/22/2021
-
- What is the time period for CGS to process the enrollment application after the fingerprint-based background check is done?
-
If an initial enrollment application is received by CGS and the provider or supplier is required to obtain a fingerprint-based background check, CGS will delay processing of the application until the fingerprint-based background check has been completed and the results are received. Typically, initial & change of information (COI) applications, paper based CMS-855A applications are processed within 30 calendar days of receipt. Web based initial & COI applications, are generally processed within 15 calendar days of receipt. Development for corrections, site visits, fingerprints (if required), as well as outreach outside the contractor may extend these time frames.
Reviewed 09/22/2021
-
- We are considering opening a new health care facility and have questions about the accreditation process: Can we bill Medicare before accreditation, or do we have to wait until the facility is accredited?
-
You cannot bill for services prior to the date you become accredited or pass a state survey. Here is the process:
- After the facility has been surveyed, the information will go to CMS.
- Once CMS approves, CGS will be notified and you will be sent a "tie-in notice" with your PTAN and effective date.
- When you receive that information from CGS Provider Enrollment, you may submit claims for dates of service on and after the effective date given. Note:
- For hospital inpatient stays, it will be based on discharge dates on and after the facility's effective date.
- For home health, the start of care (SOC) date cannot be prior to the effective date. For more information, refer to the "Newly Certified Home Health provider or HHH Provider Number Change" CGS Web page.
Reviewed 09/22/2021
-
- We are considering opening a new health care facility and have questions about the accreditation process: What about Medicare Advantage plans and accreditation?
-
CGS can only verify the Provider Enrollment guidelines and policies regarding Traditional Medicare and cannot offer facts and specifics regarding Medicare Advantage (MA) plans. We recommend you contact the MA plans for detailed information.
Reviewed 09/22/2021
-
- I have submitted an application via Internet Based PECOS. I need to withdraw or delete it. Can I do this in PECOS?
-
You will only be able to pull the application back if you identified signatures to be submitted electronically and the signature(s) are currently pending.
Log into PECOS.
If the application reflects a status of "Awaiting Processing", and the electronic signature is pending:
Click on 'My Associates'.
Click on 'View Enrollments'.
Look for the tracking ID affiliated with the application you want to delete under Existing Enrollments.
Click on 'Correct & Re-submit'.
Select 'Delete Application', and click 'Next Page', 'Confirm Delete'.If the application reflects a status of "Awaiting Processing", and has already been electronically signed or was identified as uploading signatures (paper):
You cannot delete the application. Please call the J15 Call Center for assistance.
Reviewed 09/22/2021
-
Updated: 06.13.2025
Join Electronic Mailing List
Print
Bookmark
Facebook
YouTube
LinkedIn
CGS Medicare Mobile App