CMS Pub. 100-08, ch. 10, § 10.4.1.3.1

A. Opening Review – Basic Activities

Except as stated otherwise in this chapter (see sections 10.3, 10.3.1 et seq., and 10.4.1 for more

details) or when a processing alternative applies, the contractor shall undertake the following:

1. Confirmation of Completion - Ensure that the provider has completed all required data

elements on the Form CMS-855, Form CMS-20134, or opt-out affidavit (including all effective

dates) and that all supporting documentation has been furnished. The contractor shall also

ensure that the provider has completed the application in accordance with the instructions (1) in

this chapter and in all other CMS directives and (2) on the Form CMS-855 or Form CMS-20134.

(The instructions on the Form CMS-855 or Form CMS-20134 shall be read and applied in

addition to, and not in lieu of, the instructions in this chapter and all other applicable CMS

directives.)

2. Verification - Verify and validate all information the provider furnished on the Form CMS-

855, Form CMS-20134, or opt-out affidavit (assuming a data source is available). (For PECOS

applications, note that PECOS will automatically verify certain information. See section 10.3 of

this chapter for more information.)

3. State Agency - Coordinate with the state and/or SOG Location as needed.

4. Exclusion/Debarment – Follow the instructions in section 10.6.6 of this chapter with respect

to reviewing the MED and SAM.

B. Paper Applications

1. General Background Information

The contractor shall begin processing the application upon receipt and shall develop for missing

certification statements and all other missing information (including the application fee) upon

review. This includes but is not limited to:

• Ensuring that all required data elements on the application have been completed and that all

required supporting documentation has been submitted

• Ensuring that the provider submitted a valid and dated certification statement signed by an

appropriate individual (e.g., the enrolling physician for Form CMS-855I applications)

• Validating all data on and submitted with the application (assuming that a data source is

available)

• As applicable, and consistent with section 10.3 of this chapter, entering into PECOS all

information contained on the application.

Except as otherwise prescribed in section 10.3 of this chapter, the contractor may begin the

verification process at any time.

2. Photocopying Pages

The contractor may accept photocopied pages in any Form CMS-855 or Form CMS-20134 it

receives so long as the application contains a valid signature. For example, suppose a

corporation wants to enroll five medical clinics it owns. The Section 5 data on the Form CMS-

855B is exactly the same for all five clinics. The contractor may accept photocopied Section 5

pages for these providers. However, valid signatures must be furnished in Section 15 of each

application.

3. White-Out & Highlighting

The contractor shall not write on or highlight any part of the original Form CMS-855 or Form

CMS-20134 application or any supplementary pages the applicant submits (e.g., copy of license).

Provider usage of white-out is acceptable, although the contractor should contact the applicant to

resolve any ambiguities. In addition, the contractor must determine whether the amount of

white-out used on a particular application is within reason. For instance, if an entire application

page is whited-out, the contractor should request that the page be resubmitted.

C. PECOS Applications

The contractor shall begin processing the application upon receipt and shall develop for

additional/clarifying/missing data consistent with the instructions in section 10.3 and other

pertinent sections of this chapter.