CMS Pub. 100-08, ch. 10, § 10.3.1.1.11

A. General Requirements

An authorized official must be a 5 percent direct owner, chairman of the board, etc., of the

enrolling provider with the authority to bind the provider, both legally and financially, to the

requirements set forth in 42 CFR § 424.510. This person must also have an ownership or control

interest in the provider--- such as the general partner, chairman of the board, chief financial

officer, chief executive officer, president, or someone holding a position of similar status and

authority within the provider organization. One cannot use a status as the chief executive officer,

chief financial officer, etc., of the provider’s parent company, management company, or chain

home office as a basis for the individual’s role as the provider’s authorized official.

Section 424.502 specifically defines an authorized official as an appointed official (for example,

chief executive officer, chief financial officer, general partner, chairman of the board, or direct

owner) to whom the organization has granted the legal authority to enroll it in the Medicare

program, to make changes or updates to the organization’s status in the Medicare program, and

to commit the organization to fully abide by the statutes, regulations, and program instructions of

the Medicare program. Note that an authorized official is not restricted to the examples of the

titles outlined above but can be a person of equivalent status who is an appointed official to

whom the organization has granted the legal authority to act on the organization’s behalf. These

additional titles could include, but are not limited to, executive director, administrator, president,

and vice-president. The contractor shall consider the individual’s title as well as the authority

granted by the organization when determining whether an individual qualifies as an authorized

official. If the contractor is unsure of an authorized official’s qualifications or authority, it shall

contact its PEOG BFL for guidance. In addition, the contractor shall obtain PEOG BFL approval

if the only role of the listed authorized official is “Contracted Managing Employee”

notwithstanding the individual’s title or other qualifications; the PEOG BFL will confirm

authority.

If the person is not listed as a “Contracted Managing Employee” in the Individual Ownership

Interest and/or Managing Control Information section and the contractor has no reason to suspect

that the person does not qualify as an authorized official, no further investigation is required.

Should the contractor have doubts that the individual qualifies as an authorized official, it shall

contact the official or the applicant's contact person to obtain more information about the

official's job title and/or authority to bind. If the contractor remains unconvinced that the

individual qualifies as an authorized official, it shall notify the provider that the person cannot be

an authorized official. If that person is the only authorized official listed and the provider refuses

to use a different authorized official, the contractor shall deny the application.

B. Number of Authorized Officials

The provider can have an unlimited number of authorized officials, so long as each meets the

definition of an authorized official. However, the provider must complete the Individual

Ownership and/or Managing Control section of the Form CMS-855A for each authorized

official.

C. Deletion of Authorized Official

For authorized official deletions, the contractor need not obtain (1) that official’s signature, or (2)

documentation verifying that the person is no longer an authorized official.

D. Change in Authorized Officials

A change in authorized officials does not impact the authority of existing delegated officials to

report changes and/or updates to the provider's enrollment data or to sign revalidation

applications.

E. Authorized Official Not on File

If the provider submits a change request (e.g., change of address) and the authorized official

signing it is not on file, the contractor shall ensure that: (1) the person meets the definition of an

authorized official; and (2) the Individual Ownership Interest and/or Managing Control

Information section of the Form CMS-855 is completed for the individual. The signature of an

existing authorized official is not needed to add a new authorized official. Note that the original

change request and the addition of the new official shall be treated as a single change request

(i.e., one change request encompassing two different actions) for purposes of enrollment

processing and reporting.

F. Effective Date

The effective date in PECOS for an authorized official should be the date of signature.

G. Social Security Number

To be an authorized official, the person must have and submit an SSN. The individual may not

use an Individual Taxpayer Identification Number (ITIN) in lieu of an SSN in this regard.

H. Identifying the Provider

As stated earlier, an authorized official must be an authorized official of the provider, not of an

owning organization, parent company, chain home office, or management company. Identifying

the provider is not - for purposes of determining an authorized official’s qualifications -

determined solely by the provider’s tax identification number (TIN). Rather, the organizational

structure is the central factor. For instance, suppose that a chain drug store, Company X, wants

to enroll 100 of its pharmacies with the contractor. Each pharmacy has a separate TIN and must

therefore enroll separately. Yet all of the pharmacies are part of a single corporate entity –

Company X. In other words, there are not 100 separate corporations in our scenario, but merely

one corporation whose individual locations have different TINs. Here, an authorized official for

Pharmacy #76, can be someone at X’s headquarters (assuming that the definition of authorized

official is otherwise met), even though this main office might be operating under a TIN that is

different from that of #76. This is because headquarters and Pharmacy #76 are part of the same

organization/corporation. Conversely, if #76 was a corporation that was separate and distinct

from Company X, only individuals that were part of #76 could be authorized officials.

I. Signatory Requirements

1. Valid Signatures – See section 10.3.1.1.10(A) of this chapter for information on the types of

acceptable signatures. If the contractor receives a digital signature that differs from those

described in section 10.3.1.1.10(A), the contractor shall contact its PEOG BFL for guidance.

2. Form CMS-855A Initial Applications – For these transactions, an authorized official must

sign and date the certification statement.

3. Change Requests and Revalidations - For these transactions, an authorized or delegated

official may sign the certification statement. This applies to: (1) signatures on the paper Form

CMS-855; (2) signatures on the certification statement for Internet-based provider enrollment;

and (3) electronic signatures.

4. The authorized official’s telephone number can be left blank. No further development

is needed.