CMS Pub. 100-08, ch. 10, § 10.2.1.9

A. General Background Information

For purposes of provider enrollment only, there are several types of IHS facilities: (1) those

that are wholly owned and operated by the IHS; (2) facilities owned by the IHS but tribally

operated; and (3) facilities wholly owned and operated by a tribe, though under the general

IHS umbrella. When an IHS facility wishes to enroll with the Part A contractor, it may

check in Section 2A of the Form CMS-855A either (a) “Indian Health Services Facility” or

(b) the specific provider type it is. For instance, if an IHS hospital is involved, the provider

may check “Indian Health Services Facility” or “Hospital” on the application - or perhaps

both. Even if it only checked “Hospital,” the LBN or DBA Name will typically contain some

type of reference to Indian Health Services. The contractor will therefore know that an IHS

facility is involved.

The overwhelming majority of IHS facilities on the Part A side are either hospitals, SNFs,

CAHs, or ESRD facilities. The contractor processes IHS applications in the same manner

(and via the same procedures) as it would with a hospital, SNF, etc. (This also applies to

procedures for PECOS entry.)

As for CCNs, the IHS facility uses the same series that its concomitant provider type does.

That is, an IHS hospital uses the same CCN series as a “regular” hospital, an IHS CAH

utilizes the same series as a regular CAH, and so forth.

B. Enrollment Information

IHS facilities and tribal providers may use Internet -based PECOS or the paper Form

CMS-855 enrollment application for their enrollment transactions. The designated

Medicare contractor for IHS facilities and tribal providers is Novitas Solutions

(Novitas).

If the IHS facility or tribal provider mails its Form CMS -855 to a Medicare contractor

other than Novitas, that contractor shall forward the application directly to Novitas at

the following address:

Novitas Solutions, Inc.

P.O. Box 3115

Mechanicsburg, PA 17055-1858

C. Licensure Requirements for Physicians and Practitioners Enrolling to Work in or

Reassign Benefits to an Indian Tribe or Tribal Organization

The Affordable Care Act (Pub. L 111-148) amended Section 221 of the Indian Health Care

Improvement Act such that licensed health professionals employed by a tribal health program are,

if licensed in any state, exempt from the licensing requirements of the state in which the tribal

program performs the services described in the contract or compact of the tribal health program

under the Indian Self-Determination and Education Assistance Act (ISDEAA) (25 U.S.C. 450, et

seq.). Pursuant to this statutory provision, therefore, a physician or practitioner need only be

licensed in one state – regardless of whether that state is the one in which the individual practices

– if the individual is employed by a tribal health program performing services as permitted under

the ISDEAA (see Pub. 100-04, chapter 19, section 10 for definitions).

The contractor shall apply this policy when processing applications from these individuals. In

terms of the effective date of Medicare billing privileges, the contractor shall continue to apply the

provisions of 42 CFR §§ 424.520(d) and 424.521(a) and section 10.6.2 of this chapter.

D. Additional Information

For additional general information on IHS facilities, see Pub. 100-04, chapter 19.