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December 2017 Top Development Reasons for Part B CMS 855 Internet Based PECOS Applications
CGS has identified the top development reasons for CMS applications, submitted by Internet Based PECOS. As you are completing the enrollment applications, please review to ensure you are completing the forms correctly and submitting the necessary supporting documents to avoid any delays in processing your request.
Choose from the application-specific topics below to expand and collapse the development reason details.
CMS 855I and 855B Application
| Supporting Documentation |
For Nurse Practitioners and Clinical Nurse Specialists, submit a copy of your degree and certification.
If you are enrolling as a Sole Proprietor, Sole Owner, Group or Organization, you must submit a copy of the IRS CP-575 (or other pre-printed IRS documentation).
If you are submitting the CMS 588, Electronic Funds Transfer (EFT) Agreement with the CMS 855B, a voided check or written letter from the bank verifying the bank account information is required to be submitted.
- Before you click begin submission, indicate you would like to upload supporting documents. Please ensure the documents are a PDF or TIFF formatted files 10MB or less. If you are unable to upload your supporting documents, send the documents via mail. Don't forget to write the Web Tracking ID on each document.
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Supporting Application – CMS 855R Reassignment of Benefits |
Signatures are required to be completed electronically or submitted via email within 20 days from the application submission date in order to process your application. If the application identifies multiple signatures, all signatures must be completed. We cannot process your application until all signatures are completed.
Any Individual Provider application (CMS 855I) containing new reassignments (855R) can be electronically signed as part of the submission process; however, you must select the Authorized/Delegated official for the Organization that is accepting the reassignment and enter that official's email address. The official will then be required to electronically sign the application by following the instruction in an email generated by PECOS. |
CMS 855R Application
| Supporting Application – CMS 855I Application |
Before you submit an 855R Reassignment of Benefits application, take a moment to verify you have an approved enrollment record in PECOS with CGS Administrators LLC.
If you do not have an approved PECOS enrollment record, you must complete and submit the CMS 855I application along with the CMS 855R application. If the CMS 855I is not submitted, this will delay the processing of the CMS 855R. Here are tips to confirm your enrollment status:
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Reassignment Summary – End Date |
Please ensure that the provider did not see a Medicare patient after the date indicated as the end date for the Reassignment Medicare ID Number (PTAN). If a claim has been paid, this may result in a overpayment. |
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