Processing of Registration Applications
Upon receipt of a Form CMS-855C registration application from an IPP entity, the contractor shall begin processing the application.
This includes:
• Ensuring that the application is complete (see section D(1) below for additional information).
• Creating a logging & tracking (L & T) record and entering the IPP entity’s information in the Provider Enrollment, Chain and Ownership System (PECOS).
• Verifying the information on the application in accordance with (1) the “limited” category of screening (see section 15.19.2.1(A) of this chapter for more information), and (2) existing processing guidelines (e.g., reviewing all entities and individuals listed on the Form CMS-855 against the Medicare Exclusion Database and SAM.
• Ensuring that the attestation identified in section 15.7.9.2 above is submitted, signed by an authorized official, and contains the required language.
• As needed, asking the entity for additional or clarifying information using the procedures outlined in this chapter and other applicable CMS directives; this may include information – beyond the attestation itself – that is necessary to determine whether the entity is indeed in compliance with the provisions of 42 CFR §424.66.
• Assigning specialty code C2.
• Assigning a Provider Transaction Access Number (PTAN) (if the application is approved).
B. Prescreening
The contractor need not “prescreen” (as that term is described in section 15.7.1.1 of this chapter) the registration application.
C. Returns
Section 15.8.1 of this chapter outlines the reasons for which the contractor may immediately return a Form CMS-855C. If the contractor determines that one or more of these reasons applies, it shall return the registration application in accordance with the instructions outlined in that section.
D. Development Issues
If, in response to a development request, the IPP entity indicates that it is unable to furnish certain data elements because said elements do not apply to it, the contractor shall contact its CMS Provider Enrollment & Oversight Group Business Function Lead (PEOG BFL) for guidance.
E. Timeliness and Accuracy Standards
The timeliness and accuracy standards in sections 15.6.1.1.3, 15.6.1.2, 15.6.2.1, and 15.6.2.2 of this chapter apply to the processing of IPP initial applications and changes of information. Should the contractor exceed timeliness standards due to the requirements of sections 15.7.9.1 through 15.7.9.7, the contractor shall note the provider file in accordance with section 15.7.3 of this chapter.
F. HPID/OEID
The algorithm for the HPID/OEID is similar to that of the National Provider Identifier in that it will be 10 digits in length and will begin with either a “7” (HPID) or a “6” (OEID). The HPID/OEID will replace the placeholder NPI for IPP entities only.
Disposition of Registration Applications
If the contractor determines that the IPP entity meets all necessary requirements, it shall send an e-mail to its CMS Provider Enrollment & Oversight Group Business Function Lead (PEOG BFL) that contains: (1) the entity’s legal business name, “doing business as” name (if applicable) and HPID or OEID; (2) a draft approval letter patterned after the applicable model letter in section 15.7.9.7; and (3) any issues the contractor encountered in its review. The PEOG BFL will review the matter and advise the contractor as to how to proceed.
If PEOG authorizes the approval, the contractor shall (1) switch the Provider Enrollment, Chain and Ownership System (PECOS) record to “Approved,” (2) establish an effective date that is the date on which the contractor approved the application, (3) assign a Provider Transaction Access Number (PTAN) or National Supplier Clearinghouse number (as applicable), and (4) send the approval letter via regular mail or e-mail to the entity no later than 3 business days after the contractor received authorization of the approval from PEOG.
After the entity is registered, the contractor (consistent with § 424.66(a)(5)) may request additional information in order to confirm the entity’s continued compliance with 42 CFR §424.66.
B. Denial
If the contractor determines that the entity does not meet all necessary requirements, it shall send an e-mail to its PEOG BFL that contains: (1) the entity’s legal business name, “doing business as” name (if applicable), and HPID or OEID; (2) a draft denial letter patterned after the applicable model letter in section 15.7.9.7; and (3) the contractor’s rationale for proposing to deny the application. The PEOG BFL will review the matter and advise the contractor as to how to proceed.
Grounds for denial include, but are not limited to, the following:
(1) The entity does not comply with all applicable registration requirements.
(2) The entity does not satisfy all of the requirements described in 42 CFR §424.66. (The contractor can contact its PEOG BFL for assistance on this issue.)
(3) The entity or any of its 5 percent or greater direct or indirect owners, managing employees, corporate officers, or corporate directors - or any entity or individual with a general partnership interest or a 10 percent or greater limited partnership interest in the entity - is excluded or debarred per the Medicare Exclusion Database (MED) and the SAM.
If the contractor believes that any other ground for denial exists, it shall include this in its e-mail to its PEOG BFL.
If PEOG authorizes the denial, the contractor shall (1) switch the PECOS record to “Denied,” and (2) send the denial letter via certified mail to the entity no later than 3 business days after the contractor received authorization of the denial from PEOG.
As indicated in the model denial letter in section 15.7.9.7, an entity may appeal the denial of its IPP registration application. Although IPP entities are neither providers nor suppliers, the procedures in sections 15.25.2 through 15.25.2.3 of this chapter shall apply to IPP appeals.
C. Rejection
The Form CMS-855 shall be rejected if (1) the entity fails to furnish all required information on the form within 30 calendar days of the contractor’s request to do so, or (2) the entity fails to timely submit new or corrected information in the scenarios described in section 15.8.2 of this chapter. (This includes situations in which information was submitted, but could not be verified.) The basis for rejection shall be 42 CFR §424.525(a). The rejection letter shall follow the format of the applicable letter in section 15.7.9.7 and shall be sent via regular mail no later than 5 business days after the contractor determines that the application should be rejected.
Prior PEOG approval of the rejection is unnecessary. However, as stated earlier, if the entity indicates that it is unable to furnish certain data elements because said elements do not apply to it, the contractor shall contact its PEOG BFL for guidance.
Revocation of Registration
Grounds for revocation include, but are not limited to, the following:
(1) The entity no longer complies with all applicable registration requirements.
(2) The entity no longer appears to be in compliance with the provisions of 42 CFR §424.66. (The contractor can contact its PEOG BFL for assistance regarding grounds (1) and (2).)
(3) The entity has not complied with the terms of its signed Form CMS-855 certification statement (e.g., has not timely submitted an update to its registration information).
(4) The entity or any of its 5 percent or greater direct or indirect owners, managing employees, corporate officers, or corporate directors - or any entity or individual with a general partnership interest or a 10 percent or greater limited partnership interest in the entity - is excluded or debarred per the Medicare Exclusion Database (MED) and/or the SAM..
If the contractor believes that any other ground for revocation exists, it shall include this in its e-mail to its PEOG BFL.
If PEOG authorizes the revocation, the contractor shall (1) switch the PECOS record to “Revoked,” and (2) send the revocation letter via certified mail to the entity no later than 5 business days after the contractor received authorization of the revocation from PEOG.
As indicated in the model revocation letter in section 15.7.9.7 below, an entity may appeal the revocation of its IPP registration. Although IPP entities are neither providers nor suppliers, the procedures in sections 15.25.2 through 15.25.2.3 of this chapter shall apply to IPP appeals.
Changes of Information and Other Registration
Transactions
An IPP entity is required to submit changes to its Form CMS-855C information in accordance with the terms of its signed Form CMS-855C certification statement. The contractor shall process such changes in accordance with existing instructions.
B. Other Transactions
1. Deactivations – The contractor shall not deactivate an entity’s IPP registration for any reason unless CMS instructs the contractor to do so.
2. Voluntary Terminations – If an IPP entity submits a voluntary termination application, the contractor shall process it in accordance with existing instructions.
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