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Developing for Information on a CMS-855 Application (GEN)
Posted September 21, 2006
Per the Medicare Program Integrity Manual (PIM), Chapter 10, §3: If the provider: (1) files an application with at least one missing required data element or (2) fails to submit all required supporting documentation, the contractor shall send a letter to the provider to develop for that information.
The following situations are the top reasons that development is required on an application:
- Blank sections on the application. The Medicare Program Integrity Manual states: “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 pre-screening letter requesting the provider to furnish the missing data on the CMS-855.”
“The contractor shall instruct the provider to print out the page(s) containing the missing data; to enter the data on the blank page; to sign and date a new, blank certification statement; and to send it to the contractor.”
- All applications MUST INCLUDE the following attachments:
- National Provider Identifier (NPI) notification from the National Plan and Provider Enumerator System (NPPES).
- CMS 588 Electronic Funds Transfer (EFT) Authorization Agreement (with all new enrollments or changes to existing files).
- A copy of New York State license (new to carrier).
- Copy(s) of all professional school degrees or certificates, or evidence of qualifying course work.
- A copy of the CP575 or quarterly deposit slip.
- A copy of the National Certification for Nurse Practitioners (if applicable).
- A copy of the Commission on Dietetic Registration (CDR) Card and a copy of the New York State license (if applicable).
- Participation agreement (if applicable). Participation effective date is based on postmark of envelope or date of fax.
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