Revised CMS-855 Medicare Enrollment Applications 

The Office of Management and Budget recently approved changes to the Medicare Enrollment Applications (CMS-855).  The Centers for Medicare & Medicaid Services (CMS) has placed the revised enrollment applications on their website.  You may access these forms via Highmark Medicare Services’ website at www.highmarkmedicareservices.com. 

With the exception of specialty hospitals who are required to use the revised application immediately, Highmark Medicare Services will accept the 2006 version of the CMS-855 for all providers and suppliers through June 2008.  However, we encourage you to submit the revised version of the application.  Please review MLN Matters Number SE0810 for more details on the new forms.

Reasons for Using the Enrollment Process:

• initial enrollment
• change of information
• voluntary termination
• change of ownership
• acquisition/merger
• consolidation
  

In order to receive a Medicare Provider Identification Number to bill for Part A Medicare services or to make a change in the information on file regarding a Medicare Part A provider, an 855A Provider Enrollment form must be sent to the Fiscal Intermediary (FI).  If you are unsure as to your servicing intermediary, consult the CMS website at for a listing of FIs for the various states.   NOTE:  Providers that are part of a chain or that share fiscal data with other enrolled providers may choose the same Fiscal Intermediary even if they are not located in the area normally serviced by that FI.

855A Provider Enrollment Form:  The CMS 855A Medicare Provider Enrollment form can be accessed at http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp on the CMS website.  Also, more information is available for those institutional providers who are enrolling into the Medicare program by visiting the CMS website http://www.cms.hhs.gov/MedicareProviderSupEnroll/.

Home Health, Hospice and Rural Health Clinics:  Home Health Agencies (HHA), Hospices and Rural Health Clinics should submit their applications to their regional home health or regional rural health clinic intermediary.   (Highmark Medicare Services is not a regional home health intermediary, but does act as a regional rural health clinic intermediary).   If any of these facilities is "provider based", it should submit its application to the parent provider's Fiscal Intermediary.   The form should contain all required documentation and original, authorized signatures.   Remember to date the form.

Electronic Funds Transfer:  Medicare payments due a provider or supplier of services may be sent to a bank (or similar financial institution) for deposit in the provider/supplier’s account so long as the following requirements are met:

• The bank may provide financing to the provider/supplier, as long as the bank states in writing, in the loan agreement, that it waives its right of offset. Therefore, the bank may have a lending relationship with the provider/supplier and may also be the depository for Medicare receivables; and
• The account is in the provider/supplier’s name only and only the provider/supplier may issue any instructions on that account. The bank shall be bound by only the provider/supplier’s instructions. No other agreement that the provider/supplier has with a third party shall have any influence on the account. In other words, if a bank is under a standing order from the provider/supplier to transfer funds from the provider/supplier’s account to the account of a financing entity in the same or another bank and the provider/supplier rescinds that order, the bank honors this rescission notwithstanding the fact that it is a breach of the provider/supplier’s agreement with the financing entity.   NOTE:  Irrespective of the language in any agreement a provider/supplier has with a third party that is providing financing, that third party cannot purchase the provider/supplier’s Medicare receivables.
  

Steps to Obtaining Approval for Issuance of a Medicare Provider Identifier: 
If not already contacted, the provider must contact the local State Agency to set up an on-site visit. To access the local State Agency, visit the CMS website.

If the provider is contacted for additional information, the information must be submitted immediately to ensure the timely processing of the application.

After credentialing the provider and verifying information submitted on the 855A form, Highmark Medicare Services will make one of three decisions:

• Recommendation for Approval
• Recommendation for Denial
• Return for Additional Information.

The final approval is made by the CMS Regional office, along with assignment of a Medicare identification number (if necessary).

Time Frame for Application Processing:

Initial Application (Including CHOWS [Buyer], Acquisitions, Mergers and Consolidations)

Contractors are required to process 80% of applications within 60 calendar days of receipt, process 90% of applications within 120 calendar days of receipt and process 99% of applications within 180 days calendar days of receipt.  The Centers for Medicare and Medicaid Services (CMS) may then take an additional 6-9 months to make the final determination.

Reactivations and Changes (Including CHOWS [Seller])

Contractors are required to process 80% of applications within 45 calendar days of receipt, process 90% of these type of applications within 60 calendar days of receipt and process 99% of these applications within 90 calendar days of receipt.

For initial enrollments, set-up in the standard FISS System occurs after the final notice (Tie-In) is received from CMS.  The Medicare Reimbursement area will be in contact for any additional information is needed, and will send you a welcome letter when their process has been completed.  At this point, you may begin to bill Medicare.