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Common Errors on the CMS-855 Application (GEN) - Revised 11-1-07
Posted November 1, 2007
- REQUIRED SECTIONS LEFT BLANK. We MUST require providers to complete those sections and return with new certification statement. Per Pub. 100-08, Medicare Program Integrity Manual, Chapter 10, effective July 3, 2006:
Even if the provider's application contains missing information that is nevertheless detected elsewhere on the form, in the supporting documentation, or on another enrollment form, the contractor must still send a prescreening letter requiring the provider to furnish the missing data on the CMS-855.
- When submitting CMS-855 application sections that were requested on the prescreening form, the provider MUST include a NEW CERTIFICATION PAGE signed and dated.
- The CMS-855R reassignment application must be signed and dated by BOTH the provider and the A/O-D/O of the group.
- EFFECTIVE DATES: Providers must enter the effective date in EVERY section that asks for it. One that is frequently missed is on the 855R - Section l.
- CMS-855I: Providers who are rendering ALL of their services as a group member complete Sections 1, 2, 3 & 4B1 and should then SKIP to Section 13. They DO NOT HAVE TO COMPLETE the sections in between.
- SOLO providers must complete Section 4C and enter their personal National Provider Identifier (NPI) in this section.
- Physician Assistants, SOLE owners of a professional corporation, association, or limited liability company (e.g., PC, PLLC, etc.), and providers reassigning benefits must enter their NPI in 'Section 1: BASIC INFORMATION - A' of the CMS-855I.
- SOLE owners of a professional corporation, association, or a limited liability company (e.g., PC, PLLC, etc.) must enter the BUSINESS NPI in Section 4A and 4C and their INDIVIDUAL NPI in Section 1A. Medicare Identification Number for Section 1A would be "pending."
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