CMS Pub. 100-08, ch. 10, § 10.3.3.2

Agreement

(Rev. 13355; Issued: 08-13-25; Effective: 05-05-25; Implementation: 05-05-25)

This agreement establishes that the Medicare provider/supplier accepts assignment of the

Medicare Part B payment for all services (1) for which the participant is eligible to accept

assignment under the Medicare law and regulations and (2) which are furnished while the

agreement is in effect. (This only applies to suppliers that complete the Forms CMS-855B,

CMS-855S, and CMS-855I.) The contractor shall follow the instructions in CMS Pub. 100-

04, chapter 1, sections 30 through 30.3.12.3 when handling issues related to par agreements

and assignment. Queries concerning the interpretation of such instructions shall be referred to

the responsible CMS component.

Individual physicians and non-physician practitioners who only reassign benefits to a

clinic/group practice inherit the par status established by the clinic/group practice;

accordingly, these physicians and non-physician practitioners need not submit the Form

CMS-460. However, if the individual physician/practitioner maintains a private practice

separate from the reassignment, the individual may designate the individual’s own par status.

See the instructions in CMS Pub. 100-04, chapter 1, section 30 for applying the correct par

status to clinic/group practices, organizations and individuals in private practice.

A. PECOS Information

All suppliers must choose to be either par or non-par when enrolling and must maintain the

same par status across all lines of business. The contractor shall search PECOS to determine

if an enrollment already exists with the enrolling provider/supplier’s legal business

information (i.e.: legal business name, federal tax identification number).

No par status change shall be made by the contractor without confirmation from the

provider/supplier first. In the event that a provider/supplier submits a par agreement and is

currently enrolled as non-par, the contractor must confirm with the provider/supplier that the

change in the par status is valid for all lines of business. Likewise, if a provider/supplier does

not submit a par agreement, and they are enrolled as par or non-par, the contractor shall

confirm that the provider/supplier is not changing the current par status across all lines of

business. Note also that an already-enrolled supplier is not required to submit a new CMS-

460 if they are enrolling in another state or contractor jurisdiction.

B. Valid signatures

For paper applications, handwritten (wet) signatures in ink and digital/electronic signatures

(digital or electronic signatures such as those created by digital signature options created in

software, such as Adobe) are acceptable. For web applications, the supplier can sign it

electronically or upload the signature and then submit the application. The contractor shall

contact its PEOG BFL for questions regarding electronic signatures.