Changes to Provider Enrollment Information: Questions and Answers
1) What is the procedure for changing my enrollment information?
You are required to notify WPS Medicare's Provider Enrollment department within 90 days after the effective date of all changes to information on your enrollment record.
Note: Independent diagnostic testing facilities (IDTFs) are required to report changes in ownership, changes of location, changes in general supervision, and adverse legal actions within 30 days of the effective date of the change. IDTFs must report all other changes of information within 90 days of their effective date.
All changes must be reported on the appropriate enrollment form-CMS 855B, CMS 855I, or CMS 855R. Note that these forms require that the NPI be reported. Copies of appropriate documents needed to support the requested change must be submitted with the enrollment form.
An NPI is not required, however, for changes of information reporting a voluntary termination or the death of a provider, if the provider has not previously obtained an NPI.
An individual or entity reporting a change of information may be required to submit a complete CMS 855I or CMS 855B to update their Medicare enrollment information. If the required CMS 855I or CMS 855B is not submitted within 60 days of the request, the change of information will not be processed, and the provider's billing privileges will be subject revalidation requirements per 42 CFR 424.15..
Note: If an enrolled entity obtains a new employer identification number, it is not considered a "change of information" for Medicare enrollment purposes. Rather, it is considered to be a new entity, and a new enrollment form must be completed in its entirety. Please contact our Provider Enrollment department to verify that you are completing the correct forms for your situation.
2) I originally enrolled with a temporary license and am now ready to submit my permanent license. How do I report this to WPS?
Submit your permanent license information on the CMS 855I application form as a change of information, including a new signature and date in Section 15. Include your NPI on the form and enclose a copy of your permanent license
Page Last Updated: Monday, 21-Jul-2008 10:50:26 CDT
