Novice Know How - Requirements for Provider Changes to Provider Enrollment Information
The Centers for Medicare & Medicaid Services (CMS) requires that a provider must notify Medicare of certain Provider Enrollment information changes within 90 days.
In order to prevent a Do Not Forward (DNF) flag from being added to a provider file, a provider must promptly report Special Payments address and/or Bank Routing/Account number change(s) to the carrier's Provider Enrollment department. Medicare cannot forward checks and Remittance Notices if a provider's file is flagged with DNF. Once effectuated, a DNF Flag cannot be removed from the provider's file until a CMS Form 855 application is received to notify Medicare of the updates.
At this time, CMS requires that any individual, group, or organization making a change to their pay-to address (Special Payments address) without an initial enrollment application (CMS Form 855) on file must complete one in its entirety before a change is made to a pay-to address. For example, if you or your organization enrolled prior to 1998, this may affect you.
An individual solo practitioner must complete a CMS Form 855I for any of the following changes to his/her 'Individual Medicare file':
- Name changes/updates (marriage, divorce or legal name change)
- Address additions/deletions
- Adding/changing a Billing Agency
- Changing/updating the provider specialty
- Changing/updating an effective date or termination date
An organization must complete the CMS 855B for the following changes to their 'Organization/Group Medicare file':
- Changing/updating an effective date or termination date
- Address additions/deletions
- Adding/changing a Billing Agency
- Changing/Deleting the Authorized Official
- Changing/Deleting the Delegated Official
- Terming a Physician Assistant PIN within your group
Group members must complete the CMS Form 855R to make the following changes to their reassignment:
- Terminate a current Reassignment
- Change the effective date/termination date on a reassignment
Applications forms for changes must be sent to the appropriate WPS Medicare location:
For Wisconsin/Illinois/Michigan:
WPS Medicare Part B
Provider Enrollment Unit
P O BOX 8248
Madison, WI 53708-8248
For Minnesota:
WPS Medicare Part B
Provider Enrollment Unit
8120 Penn Ave. Suite 200
Bloomington, MN 55431
For additional information concerning changes to provider enrollment files and for other helpful Medicare Provider Enrollment information, visit the Provider Enrollment homepage on the WPS Medicare Website. It is available on our Website.
