CMS Pub. 100-08, ch. 10, § 10.3.1.3.4

A. Practice Location Verification

The contractor shall verify that the practice locations listed on the application 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. To reiterate: the practice location address in the Practice Location Information section

must be a valid address with USPS; addresses entered in PECOS are verified via computer

software to determine if they are valid and deliverable.

Each practice location is to be verified. However, the contractor shall not call the practice

locations (or the contact person listed on the application) to validate them. The verification

means described in the previous paragraph (and, if applicable to the provider/supplier type, a site

visit) shall instead be used. Only if development is needed to confirm the location (e.g., USPS

cannot validate the location) may the contractor telephone the location or contact person.

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

each practice location listed.

If the “Business Structure Information” checkboxes in Section 4A are blank, the contractor can

confirm the information via the PCV, e-mail, or fax.

A practitioner who only renders services in patients' homes (i.e., house calls) must supply the

practitioner’s home address in the Practice Location Information section. In addition, if a

practitioner renders services in a retirement or assisted living community, the Practice Location

Information section must include the name and address of that community. In either case, the

contractor shall verify that the address is a physical address. Post office boxes and drop boxes

are not acceptable.

If the physician or non-physician practitioner uses a home address as the practice location and

exclusively performs services in patients’ homes, nursing homes, etc., no site visit is necessary.

If an individual practitioner (1) is adding a practice location and (2) is normally required to

complete a questionnaire in the Personal Identifying Information section of the Form CMS-855I

specific to its supplier type (i.e., physical therapists), the person must submit an updated

questionnaire to incorporate services rendered at the new location.

For suppliers paid via the Multi-Carrier System (MCS)--and except as otherwise stated in section

10.3--the practice location name entered in PECOS shall be the legal business name.

B. Telephone Number Verification

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

the supplier must report one. If the supplier does not, the contractor shall develop for a phone

number using the procedures outlined in this chapter.

C. Unintended Changes

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

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

still be updated via the Form CMS-855I.

D. Remittance Notices/Special Payments Mailing Address section

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

• One of the supplier’s practice locations

• A P.O. Box

• 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.)

• The supplier’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.

• Correspondence address

If neither box in this section is checked and no address is provided, the contractor can contact the

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

“special payments” address is the same as the practice location, no further development is

needed. If, however, the supplier wants payments to be sent to a different address, the address in

the Remittance Notices/Special Payments Mailing Address section must be completed via the

Form CMS-855I.

E. 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 supplier’s “special payment” address (Business

Information of the Form CMS-855I) or EFT information has changed. The supplier should

submit a Form CMS-855I to change this address; if the supplier does not have an established

enrollment record in PECOS, it must complete an entire Form CMS-855I and Form CMS-588.

The Durable Medical Equipment MAC is responsible for obtaining, updating, and processing

Form CMS-588 changes.

In situations where a supplier is closing the business and has a termination date (e.g., is retiring),

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 supplier to complete the “special payment” address section of the Form CMS-

855I and to sign the certification statement. The contractor, however, shall not collect any other

information unless there is a need to do so.

F. EFT

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

supplier 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 supplier that currently receives paper checks submits a Form CMS-855I change

request – no matter what the change involves – the supplier 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.

• The contractor shall also verify that the bank account complies with Pub. 100-04, chapter 1,

section 30.2.

(Once a supplier changes its method of payment from paper checks to EFT, it must continue

using EFT. A supplier cannot switch from EFT to paper checks.)

G. Solely-Owned Organizations

1. Paper Applications

All pertinent data for solely-owned organizations can be furnished via the Form CMS-855I

alone. The contractor, however, shall require the supplier to submit a Form CMS-855B and

CMS-855I if, during the verification process, it discovers that the supplier is not a solely-owned

organization. (NOTE: A solely-owned supplier type that normally completes the Form CMS-

855B to enroll in Medicare must still do so. For example, a solely-owned LLC that is an

ambulance company must complete the Form CMS-855B even though the Practice Location

Information/Sole Proprietor/Sole Proprietorship section makes mention of solely-owned LLCs.

Use of the Practice Location Information section of the Form CMS-855I is limited to suppliers

that perform physician or practitioner services.)

(Sole proprietorships need not complete the Business Information portions of Section 4 of the

Form CMS-855I. Per definition, a sole proprietorship is not a corporation, professional

association, etc. Do not confuse a sole proprietor with a physician whose business is that of a

corporation, LLC, etc., of which the physician is the sole owner.)

In the Business Information section, the supplier may list a type of business organization other

than a professional corporation, a professional association, or a limited liability company (e.g.,

closely-held corporation). This is acceptable so long as that business type is recognized by the

state in which the supplier is located.

The contractor shall verify all data furnished in the Business Information section (e.g., legal

business name, TIN, adverse legal actions). If the Business Information section is left blank, the

contractor may assume it does not pertain to the applicant.

A solely-owned physician or practitioner organization that utilizes the Business Information

section to enroll in Medicare can generally submit change of information requests to Medicare

via the Form CMS-855I. However, if the change involves data not captured on the Form CMS-

855I, the change must be made on the applicable CMS form (e.g., Form CMS-855B).

H. Individual Reassignment/Affiliation Information

If the applicant indicates an intention to render all or part of the individual’s services in a private

practice, clinic/group, or any organization to which benefits would be reassigned, the contractor

shall ensure that the applicant (or the group or organization, as applicable) has completed Section

4(F)(1)/(2) of the Form CMS-855I for each party to which the applicant is reassigning benefits.

The contractor shall also verify that each individual, clinic/group practice, or organization to

which benefits are being reassigned is enrolled in Medicare. If it is not, the contractor shall

enroll the individual, clinic/group practice, or organization prior to approving the reassignment.

See section 10.3.1.4 of this chapter for detailed instructions regarding the processing of

reassignments.

I. Sole Proprietor Use of EIN

The practitioner may obtain a separate EIN if the individual wants to receive reassigned benefits

as a sole proprietor.

J. NPI Information for Groups

If a reassignee is already established in PECOS (i.e., status of "approved” unless the Form CMS-

855I is submitted for the purpose of revalidation), the reassignor need not submit the

reassignee’s NPI in Section 4(F) of the Form CMS-855I.

K. Out-of-State Practice Locations

Except as stated otherwise in section 10.3 or in another CMS directive, if a supplier is adding a

practice location in another state, a separate, initial Form CMS-855I enrollment application is

required for that location even if:

• The location is part of the same organization (e.g., a solely-owned corporation),

• The location has the same tax identification number (TIN) and legal business name (LBN),

and

• The location is in the same contractor jurisdiction.

To illustrate, suppose the contractor’s jurisdiction consists of States X, Y, and Z. Dr. Jones, a

sole proprietor, is enrolled in State X with 2 locations. Jones wants to add a third location in

State Y under Jones’ social security number and the sole proprietorship’s employer identification

number. A separate, initial Form CMS-855I application is required for the State Y location.