A & R Provider Enrollment Information
Effective July 1, 1997, the Centers for Medicare and Medicaid (CMS) assigned the responsibility for enrolling health care providers of the Medicare Program to Fiscal Intermediaries.
- Fiscal Intermediaries contract with CMS under Medicare Part A to service health care organizations. Fiscal Intermediaries do not service Physician Groups or Individuals.
- Physician Groups or Individuals who wish to enroll in the Medicare Program should contact the appropriate Part B Carrier. WPS only services Medicare Part A Providers.
Refer to the Intermediary-Carrier Directory located on CMS’ Website for listing of Fiscal Intermediaries and Carriers: http://www.cms.hhs.gov/apps/contacts/default.asp? 
.
Provider Enrollment Submission and Process
- As of June 5, 2006, all CMS 855A applications submitted must be filed using the most current version of the CMS-855A and contain all supporting documentation, including the National Provider Identifier (NPI) received from the National Plan and Provider Enumeration System (NPPES) and the CMS-588 EFT form. If a Part A healthcare organization/provider needs a provider enrollment application, please visit CMS’ Website at: http://www.cms.hhs.gov/cmsforms/
downloads/cms855a.pdf
to download a copy of the 855A application.
Effective October 1, 2005, the Centers for Medicare & Medicaid Services will no longer allows freestanding or independent providers that enter the Medicare program to express a preference for a particular FI. The CMS Regional Offices (RO) must assign the new provider to the designated local FI. Providers that undergo a change of ownership will usually continue with the same FI that served the previous owner. New providers that belong to CMS-recognized chains have the option of being assigned to the local designated FI or to the FI that serves the chain home office. Medicare providers will no longer be able to request a change of FI. Providers must remain with the FI to which they have been assigned (Change Request 4286 dated 02/17/06). Refer to the MLN Matters article SE0582) related to this instruction is available at http://www.cms.hhs.gov/MLNMattersArticles/. Please refer to the Intermediary-Carrier Directory posted on CMS’ website for State Jurisdiction designations: http://www.cms.hhs.gov/apps/
contacts/default.asp? . - Before submitting the 855A application to the Fiscal Intermediary, please ensure all data elements of 855A application are complete and accurate. Please include all effective dates for all sections that ask for it even if the facility, organization or individual has been with the provider for a long period of time. The effective date is usually the date the individual, organization, or facility became a part of that provider. Every data element on the CMS 855A application must be fully completed regardless of 1) the relative materiality of the data elements in question 2) whether the missing data is available elsewhere on the provider's application. Failure to complete all data elements may lead to processing delays in our review of the 855A application.
Per Publication 100-08 PIM Chapter 10 Section 13.1, a provider must report a change in information (ex. change in personnel, address or authorized official) on the enrollment application within 90 calendar days of when the change occurred. Also, a provider must report a change of ownership or control within on the enrollment application within 30 calendar days. Failure to submit the changes timely could lead to the Deactivation of the billing number. Providers who fail to promptly notify a contractor of a change must complete and submit a complete Medicare 855A application to reactivate its billing privileges or, when deemed appropriate, recertify that the enrollment information currently on file with Medicare is correct. - Once completed, the provider enrollment applications must be submitted directly to your Fiscal Intermediary. WPS's mailing address for submitting provider enrollment applications is:
Delivery or Overnight Service:
WPS Medicare
Medicare Provider Enrollment South Bldg. 7th Floor
Mutual of Omaha Plaza
Omaha, NE 68175
Regular Mail Service:
WPS Medicare
Medicare Provider Enrollment
South Bldg.7th Floor
P.O. Box 1604
Omaha, NE 68101
- Provider-based Home Health Agencies (HHAs) and other provider-based units continue to submit their applications to the parent provider number’s Fiscal Intermediary, also known as “Audit Intermediary”.
All free-standing HHAs are still required to submit their enrollment application to the appropriate Regional Home Health Intermediary (RHHI). - The form must contain all required documentation and original, authorized signatures. Ensuring the application is fully completed before sending to the Fiscal Intermediary will assist in the timely completion of the application and avoid potential delays. Providers need to keep a copy for your own records.
- It is the provider’s responsibility to contact the local State Agency that handles the provider type being enrolled. The local State Agency will provide you with any State-specific forms required for your provider type. They will also do preliminary planning for any required State surveys or notice of accreditation in lieu of a survey (when this is permitted). To access the local State Agency, visit the CMS website.
- Fiscal Intermediaries can only make a recommendation to CMS Regional Office to either approve or denial the application. However, the Fiscal Intermediary can close an application due to lack of additional information as requested, which do not get forwarded to CMS. Closing an application is a decision at the FI level.
The final determination (approval or denial) is made by the CMS Regional Office, along with the assignment of a Medicare provider number (when necessary).
Should you have any questions regarding this information or have any additional questions, please feel free to contact our Provider Enrollment area at 1-866-734-9444. Refer also to our “Contacts”.
Page Last Updated: Tuesday, 15-Jul-2008 10:37:30 CDT
