CMS Pub. 100-08, ch. 10, § 10.3.1.2.10

The processing alternatives in section 10.3.1.2.10(E) are in addition to, and not in lieu of, any

other processing alternatives described in this chapter or another CMS directive. These

processing alternatives also apply notwithstanding any instruction in this chapter to the contrary.

As stated in section 10.3, however, some of the application data elements and verification

procedures that have previously been subject to a processing exception/alternative may no longer

be so or are moot under PECOS 2.0. (See section 10.3 for a discussion of such data and

procedures.) In such situations, the contractor shall disregard the exception/alternative and

follow the instructions in section 10.3 and section 10.3.1.2 through 10.3.1.2.9.

A. Supporting Documents (Section 17)

See the Supporting Documents Section of the Form CMS-855B as well as section 10.3 for

information concerning supporting documents.

B. Attachment 1 for Ambulance Service Suppliers

In section D of Attachment 1 of the Form CMS-855B, the “Land,” “Air,” and “Marine” boxes

need not be checked (or developed) if the type of vehicle involved is clear. In addition, the

contractor need not develop for the written statement signed by the President, Chief Executive

Officer, or Chief Operating Officer of the airport from where the aircraft is hangared that

furnishes the name and address of the facility.

See section 10.2.2.10 of this chapter for more detailed processing instructions on Attachment 1.

C. Attachment 2 for Independent Diagnostic Testing Facilities

See section 10.2.2.4 of this chapter for more detailed processing instructions on Attachment 2.

D. Attachment 3 for Opioid Treatment Programs

See section 10.2.7 of this chapter for more detailed processing instructions on Attachment 3.

E. Provider-Based Entities

The contractor shall adhere to the following regarding the enrollment of provider-based entities:

• Group Practice Initially Enrolling – If a group practice is enrolling in Medicare and will

become provider-based to a hospital, the group generally must enroll via the Form CMS-855B if

it wants to bill for practitioner services. The group would also need to be listed or added as a

practice location on the hospital’s Form CMS-855A.

• Group Practice Changing from Provider-Based to Freestanding – In this situation, the

hospital should submit a Form CMS-855A change request that deletes the clinic as a practice

location. The group may also need to change the type of clinic it is enrolled as; this may require

a new Form CMS-855B.

• Group Practice Changing from Freestanding to Provider-Based – Here, the hospital must

submit a Form CMS-855A change request adding the group as a practice location. The group

may also need to change the type of clinic it is enrolled as; this may require a new Form CMS-

855B.

Unless CMS instructs otherwise, the contractor shall not delay the processing of any practice

location addition applications pending receipt of provider-based attestations or CMS approval of

provider-based status.

F. Additional Processing Information and Alternatives

1. Unsolicited Additional Information

If the supplier submits additional/missing/clarifying data or documentation on its own volition

(i.e., without being contacted by the contractor), the contractor shall include this additional

data/documentation in its overall application review. Any new or changed information that a

supplier submits prior to the date the contractor finishes processing a previously submitted

change request constitutes a separate change request rather than an update to the original change

request. The contractor may process both changes simultaneously; however, the contractor shall

process the first submitted change to completion before processing the second one to completion.

2. Information Disclosed Elsewhere

If a data element on the supplier’s Form CMS-855B application is missing but the information is

disclosed (1) elsewhere on the application or (2) in the supporting documentation submitted with

the application, the contractor need not obtain the missing data via an updated Form CMS-855B

page and a newly-signed certification statement; no further development – not even by telephone

– is required. The following information, however, must be furnished in the appropriate

section(s) of the Form CMS-855B, even if the data is identified elsewhere on the form or in the

supporting documentation:

• All ownership and managing control information in the Organizational or Individual

Ownership and/or Managing Control sections of the Form CMS-855B

• Except as otherwise stated in section 10.6.6 of this chapter, any final adverse action data

requested in the Final Adverse Legal Actions/Convictions Section and the Organizational and

Individual Ownership and/or Managing Control/Final Adverse Legal Action History sections of

the Form CMS-855B

• All legal business names (LBN) or legal names (NOTE: If an application is submitted with a

valid NPI-PTAN combination but (1) the LBN field is blank, (2) an incomplete or inaccurate

LBN is submitted, or (3) the applicant includes a DBA name in the Practice Location

Information section of the Form CMS-855B -- and the contractor is able to confirm the correct

LBN based on the NPI-PTAN combination provided, the contractor need not develop.)

• All tax identification numbers (TIN)

• NPI-legacy number combinations in the Practice Location Information section of the Form

CMS-855B (NOTE: The contractor may use the shared systems, PECOS, or its provider files as

a resource to determine the PTAN or NPI before developing with the supplier.)

• Supplier type in the Identifying Information section of the Form CMS-855B

3. Supporting Documentation Resubmission

If the supporting documentation currently exists in the supplier’s file, the supplier need not

submit that documentation again during the enrollment process. The contractor shall utilize the

existing documentation for verification. Documentation submitted with a previously submitted

enrollment application (or documentation currently uploaded in PECOS) qualifies as a

processing alternative, unless stated otherwise in this chapter or another CMS directive. Also, per

section 10.6.19(H) of this chapter, the contractor shall document in PECOS that the missing

information was found elsewhere in the enrollment package. (This excludes information that

must be verified at the current point in time (i.e., a license without a primary source verification

method.) In addition, the contractor shall not utilize information submitted along with opt-out

applications for enrollment application processing or vice-versa.

4. City, State, and ZIP Code

If an address (e.g., correspondence address, practice location) lacks a city, state or zip + four, the

contractor can verify the missing data in any manner it chooses. In addition, the contractor can

obtain the zip + four from either the U.S. Postal Service or the Delivery Point Validation in

PECOS.

5. Inapplicable Questions

The supplier need not check “no” for questions that obviously do not apply to its supplier type.

6. Authorized/Delegated Official Telephone Number

The telephone numbers in these sections can be left blank. No further development is needed.