CMS Pub. 100-08, ch. 10, § 10.3.1.1.4

A. General Background

Unless CMS specifies otherwise, any change in the provider’s phone number or address that the

provider did not cause (i.e., area code change, municipality renames the provider’s street) must

still be updated via the Form CMS-855.

Any provider submitting a Form CMS-855A application must submit the 9-digit ZIP Code for

each practice location listed.

(For paper applications only - If a practice location (e.g., hospital unit) has a CMS Certification

Number (CCN) that is in any way different from that of the main provider, the contractor shall

create a separate enrollment record in PECOS for that location. (This does not apply, however,

to home health agency (HHA) branches, outpatient physical therapy/outpatient speech pathology

(OPT/OSP) extension sites, and transplant centers.))

The contractor shall verify that the practice locations listed on the application actually exist and

are valid addresses with the United States Postal Service (USPS). PECOS includes a USPS

Address Matching System Application Program Interface (API), which validates address

information entered and flags the address if it is determined to be invalid, unknown,

undeliverable, vacant, unlikely to deliver mail (No-Stat), a CMRA (i.e., UPS Store, mailboxes,

etc.), or a known invalid address false positive. These address types are not permitted in PECOS

and are flagged upon entry.

The contractor need not verify the provider’s telephone number listed on the application, though

the provider must report one. If it does not, the contractor shall develop for a phone number

using the procedures outlined in this chapter.

If the contractor cannot verify the provider’s address, the contractor shall request clarifying

information from the provider. If the provider states that the facility is not yet operational, the

contractor may continue processing the application. However, it shall indicate in its

recommendation letter that the address of the facility could not be verified. For purposes of

PECOS entry, the contractor can temporarily use the date the certification statement was signed

as the effective date.

(For paper applications only: In Section 4A of the Form CMS-855A, if the “type of practice

location” checkbox is blank, the contractor can confirm the information via the PCV, e-mail, or

fax.)

B. Do Not Forward (DNF)

Unless instructed otherwise in another CMS directive, the contractor shall follow the DNF

initiative instructions in Pub. 100-04, chapter 1, section 80.5. Returned paper checks, remittance

notices, or EFT payments shall be flagged if returned from the post office or banking institution,

respectively, as this may indicate that the provider’s “special payment” address (in the Practice

Location Information section of the Form CMS-855A) or EFT information has changed. The

provider should submit a Form CMS-855A to change this address; if the provider does not have

an established enrollment record in PECOS, it must complete an entire Form CMS-855A and

Form CMS-588.

If the provider is closing its business and has a termination date, the contractor will likely need to

make payments for prior services rendered. Since the practice location has been terminated, the

contractor may encounter a DNF message. If so, the contractor should request the provider to

complete the “special payment” address section of the Form CMS-855A and to sign the

certification statement. The contractor, however, shall not collect any other information unless

there is a need to do so or unless an instruction in this chapter states otherwise. (See section

10.6.1.3(C)(5) of this chapter for additional information.)

C. Remittance Notices/Special Payments

For new enrollees, all payments must be made via EFT. The contractor shall thus ensure that the

provider has completed and signed the Form CMS-588 and shall verify that the bank account

complies with Pub. 100-04, chapter 1, section 30.2.

If an enrolled provider that currently receives paper checks submits a Form CMS-855A change

request (no matter what the change involves), the provider must also submit a Form CMS-588

that switches its payment mechanism to EFT. (The change request cannot be processed until the

Form CMS-588 is submitted.) All future payments (excluding special payments) must be made

via EFT; once a provider changes its method of payment from paper checks to EFT, it must

continue using EFT. A provider cannot switch from EFT to paper checks. The contractor shall

verify that the bank account complies with Pub. 100-04, chapter 1, section 30.2.

The “special payment” address may only be one of the following:

(i) One of the provider’s practice locations

(ii) A P.O. Box

(iii) The provider’s billing agent. (The contractor shall request additional information if it has

any reason to suspect that the arrangement – at least with respect to any special payments that

might be made – may violate the Payment to Agent rules in Pub. 100-04, chapter 1, section

30.2.)

(iv) The chain home office address. Per Pub.100-04, chapter 1, section 30.2, a chain

organization may have payments to its providers sent to the chain home office. The provider

must list the chain home office’s LBN on the Form CMS-588. The TIN on the Form CMS-588

should be that of the provider.

(v) Correspondence address

(vi) A lockbox. (The contractor shall request additional information if it has any reason to

suspect that the arrangement, at least with respect to any special payments that might be made,

may violate the Payment to Agent rules in Pub. 100-04, chapter 1, section 30.2.)

D. Out-of-State Practice Locations

If a provider is adding a practice location in another state that is within the contractor’s

jurisdiction -- and, for PECOS applications, to the extent PECOS permits it --- a separate, initial

Form CMS-855A enrollment application is not required if all of the following conditions are

met:

(i) The location is not part of a separate organization (e.g., a separate corporation, partnership);

(ii) The location does not have a separate TIN and LBN;

(iii) The state in which the new location is being added does not require the location to be

surveyed;

(iv) Neither the new location nor its owner is required to sign a separate provider agreement;

and

(v) The provider type in question is not required to separately enroll each of its practice

locations. (For example, a federally qualified health center (FQHC) would not meet this criterion

because FQHCs must separately enroll each location.)

Consider the following examples:

EXAMPLE 1 - The contractor’s jurisdiction consists of States X, Y and Z. Jones Health Care

Facility (JHCF), Inc. is enrolled in State X with 3 sites. It wants to add a fourth site in State Y.

The new site will be under JHCF, Inc. JHCF will not be establishing a separate corporation,

LBN, or TIN for the site, and - per the state and CMS policy - a separate survey and provider

agreement are not necessary; moreover, CMS policy does not require this provider type to

separately enroll each of its practice locations. Since all 5 conditions above are met, JHCF, Inc.

can add the fourth location via a change of information request, rather than an initial application.

The change request must include all information relevant to the new location (e.g., licensure,

new managing employees). (For paper applications only---and to the extent required---the

contractor shall create a separate PECOS enrollment record for the State Y location.)

EXAMPLE 2 - The contractor’s jurisdiction consists of States X, Y and Z. JHCF, Inc., is

enrolled in State X with 3 locations. It wants to add a fourth location in State Y but under a

newly created, separate legal entity - JHCF, LP. The fourth location must be enrolled via a

separate, initial Form CMS-855A.

EXAMPLE 3 - The contractor’s jurisdiction consists of States X, Y and Z. Jones Health

Services (JHS), Inc., is enrolled in State X with 1 location. It wants to add a second location in

State Z under JHS, Inc. However, it has been determined that a separate survey and certification

of the new location are required. A separate, initial Form CMS-855A for the new location is

required.

E. Additional Practice Location Information

1. Special Payments

In the “Practice Location Information/Where Do You Want Remittance Notices or Special

Payments Sent” section, if neither box is checked and no address is furnished, the contractor can

contact the provider by telephone, e-mail, the PCV, or fax to confirm the provider’s intentions.

If the provider replies that the “special payments” address is the same as the practice location, no

further development is needed. If, however, the provider wants payments sent to a different

address, the provider must furnish this address in the “Where Do You Want Remittance Notices

or Special Payments Sent” section of the Form CMS-855A.

Note that the provider/supplier can only have one special payment address per enrollment for

both PECOS and paper applications. See section 10.3(C)(2)(b) for more information.

2. Base of Operations

In the Practice Location Information/Base of Operations section, if the “Check here” box is not

checked and no address is furnished, the contractor can contact the provider by telephone, e-mail, the PCV, or fax to confirm the provider’s intentions. If the provider replies that the base of

operations address is the same as the practice location, no further development is needed. If the

provider indicates that the base of operations is at a different location, the provider must furnish

this address in the Base of Operations section of the Form CMS-855A.

3. Vehicle Information

In the Practice Location Information/Vehicle Information section, if the vehicle certificates are

furnished but the applicable Form CMS-855A sections are blank, the contractor can verify via

telephone, the PCV, e-mail, or fax that said vehicles are the only ones the provider has.

4. Primary Practice Location (PPL) Checkboxes

The provider must identify one – but no more than one – of the practice locations it lists in

Section 4(A) as its PPL. If the provider identifies multiple PPLs or no PPLs, the contractor shall

develop for additional information/clarification consistent with the instructions in Chapter 10. If

the provider lists multiple practice locations, identifies one of them (e.g., Location A) as its PPL,

and fails to check the PPL boxes for the other listed locations (Locations B, C, and D), the

contractor can assume --- absent evidence to the contrary -- that Location A is the PPL and need

not require the provider to check “No” for the PPL checkboxes for Locations B, C, and D.

5. Date First Patient Seen

For each practice location listed in Section 4(A), the provider must identify the date (month, day,

and year) on which the first patient was or will be seen. If the provider fails to submit this data,

the contractor shall develop for it consistent with the procedures in this chapter.

6. Medical Record Storage

In Section 4(C)(2), the provider must check whether it stores its patient medical records

electronically and, if it checks “Yes,” identify the service used to store these records. In the latter

case, an actual website need not be disclosed. Only a general reference to the type of electronic

storage is required (e.g., in-house software program, online service, vendor, etc.). It lies within

the contractor’s discretion to determine whether the description – which, again, need only be

general in nature – adequately identifies the type of electronic service; if an inadequate

description is furnished, the contractor shall develop for it consistent with the procedures in this

chapter. Moreover, if a website is listed, the contractor need not access it to verify that the link is

indeed where the records are stored.

7. Provider-Based

If the provider checks the “Outpatient Provider-Based Department” (PBD) box in Section 4(A),

it must check one of the seven succeeding checkboxes that outlines the type of PBD involved.

Except if CMS directs otherwise, the contractor need not verify any of the furnished PBD data in

Section 4(A), including whether the department is indeed a PBD or the type of PBD involved. In

addition, even if the contractor knows the department is provider-based, the provider need not

check that it is a PBD. Only if the provider checks the PBD checkbox must it also identify the

type.