CMS Pub. 100-08, ch. 10, § 10.6.1.1.3

Sections 10.6.1.1.3.1, 10.6.1.1.3.2, and 10.6.1.1.3.3 outline the general steps the contractor must

undertake in a potential CHOW situation. The contractor should also review sections

10.6.1.1.3.1.1 and 10.6.1.1.4 below regarding special circumstances that might occur when

performing these steps. In addition, nothing in this section 10.6.1.1.3 et seq. prohibits the

contractor from returning or rejecting the application if grounds for doing so under this chapter

10 exist.

Except as otherwise stated, the instructions in this section 10.6.1.1.3 et seq. apply to both Form

CMS-855A and Form CMS-855B applications from certified providers.

10.6.1.1.3.1 – Step 1 - Initial Review of the CHOW Application

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

A. Process

Upon receipt of a Form CMS-855 CHOW application, the contractor shall undertake the

following (in whichever order the contractor prefers):

(i) Ensure that all data validations otherwise required per this chapter have been

performed.

(ii) Ensure that the submitted application(s) is complete consistent with the instructions in

this chapter.

(iii) Ensure that the provider has submitted all documentation otherwise required per this

chapter. For CHOW purposes, this also includes the following:

(a) Legal Documentation of CHOW - The legal documents that governed the transaction, such as

a sales agreement, bill of sale, or transfer agreement. (See section 10.6.1.1.3.1.1 below for more

information on such documents.)

(b) Form CMS-1561 (Health Insurance Benefit Agreement). (In lieu of the Form CMS-1561,

rural health clinics (RHCs) must submit the Form CMS-1561A and ambulatory surgical centers

(ASCs) must submit the Form CMS-370.) (See https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List for more information.) These forms are generally known

as “provider agreements” and “supplier agreements,” as applicable.

(c) Evidence of state licensure, if applicable. (This can be furnished consistent with existing

instructions in this chapter concerning submission of evidence of state licensure.)

(d) Evidence of successful electronic submission of the Form HHS-690 through the Office of

Civil Rights (OCR) portal, as applicable. (Evidence should be either written or electronic

documentation.) (See https://www.hhs.gov/sites/default/files/forms/hhs-690.pdf for more

information.)

(e) Applicable CMS Form that requests certification in Medicare. (These include, for example,

CMS-377 for ASCs, CMS-3427 for end-stage renal disease (ESRD) facilities, etc.) (See

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List for more

information.)

(f) Form CMS-1539 - Medicare/Medicaid Certification and Transmittal

(https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS011722).

(g) Form CMS-2567 – Statement of Deficiencies and Plan of Correction

(https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS008860).

(h) For skilled nursing facilities (SNFs), a signed patient transfer agreement. (See

https://www.cms.gov/Medicare/Provider-Enrollment-and-

Certification/SurveyCertEmergPrep/Downloads/Facility-Transfer-Agreement-Example.pdf for

an example.)

(The provider must complete, sign, date, and include the applicable CMS forms described in this

subsection (A)(iii); the provider need not, of course, complete those sections of the forms that are

reserved for CMS. For organizational providers, an authorized official (as defined in § 424.502)

must sign the forms; for sole proprietorships, the sole proprietor must sign.)

Notwithstanding the foregoing, if any document in subsection (A)(iii)(b), (d), (e), (f), (g), or (h)

above is missing, unsigned, undated, or otherwise incomplete, the contractor need not develop

for the form(s) or the information thereon; the contractor shall instead notify the state in its

recommendation letter which document(s) was/were missing or otherwise incomplete. For all

other missing or incomplete required documentation, the contractor shall follow the normal

development instructions in this chapter.

Note that if the application is rejected and this results in the expiration of the applicable time

period for reporting the change (e.g., 30 days), the contractor shall e-mail its PEOG BFL

notifying the latter of the rejection. PEOG will determine whether the provider’s/supplier’s

billing privileges should be deactivated under § 424.540(a)(2) or § 424.550(b)(2) or revoked

under § 424.535(a)(1) or (a)(9). PEOG will notify the contractor of its decision.

(iv) Ascertaining whether a formal § 489.18 CHOW has occurred – This involves performing

all necessary background research, which can include:

• Reviewing the sales or lease agreement

• Reviewing the ownership information in Sections 2, 5, and 6 of the Form CMS-855A (or

Sections 5 and 6 of the Form CMS-855B)

• Reviewing whether the provider checked “Yes” or “No” to the question in Section 2 of the

Form CMS-855A concerning the acceptance of assignment of the provider agreement.

• Contacting the provider(s) to request clarification of the sales agreement, etc. (Unless

otherwise stated in this chapter, the provider must furnish any such clarification in writing; e-mail (including the PCV) is acceptable.)

(v) As applicable, take into account the supplemental instructions in sections

10.6.1.1.3.1(B), 10.6.1.1.3.1.1 and 10.6.1.1.4 of this chapter.

B. Additional Instructions

1. TIN Change - While a CHOW is typically accompanied by a TIN change, this is not always

the case. On occasion, the TIN remains the same; conversely, sometimes the provider is

changing its TIN but not its ownership. In short, while a change of TIN (or lack thereof) is

evidence that a CHOW may or may not have occurred, it is not the most important factor; rather,

the change in the provider’s ownership arrangement is the central issue. Hence, the contractor

shall review the sales/lease agreement closely, for this will help indicate whether a CHOW has

occurred. Again, CMS stresses that the terms and conditions of the sales agreement are the

primary indicator of the existence or non-existence of a CHOW.

2. Request for Information and/or Clarification – If, after its initial review under subsection (A),

the contractor remains uncertain as to whether a CHOW has taken place, the contractor: (i)

reserves the right to request any clarifying information from the provider (e.g., additional

documentation concerning the sale); and/or (ii) may contact its PEOG BFL or the SOG Location

for assistance. (This may include situations where, for instance, (i) the provider believes that the

transaction is merely a stock transfer but the contractor disagrees, and (ii) the contractor is

uncertain whether the provider is accepting assignment.)

3. Acceptance of Assignment – Regardless of the provider’s response to the Form CMS-855

question concerning whether the provider accepts assignment, the contractor shall review the

sales/transfer agreement and any other documentation to confirm whether the provider’s

response is consistent with the agreement. (For example, if the provider responds “no” to the

question, the contractor shall review the sales agreement to ensure consistency.) If an

inconsistency is discovered, the contractor shall contact the provider for clarification.

4. Situations Requiring Referral to PEOG – The contractor shall refer the case and all supporting

documentation (e.g., sales agreement) to its PEOG BFL in either of the following situations:

• The provider reports a CHOW based strictly on a relinquishment by the owner of all

authority and responsibility for the provider organization without a § 489.18-level change of

ownership. (For instance, the sales agreement indicates that the provider is selling only 10%

of its ownership stake but the provider claims the transaction is a CHOW because it is

relinquishing all control of the provider to the party to which its 10% ownership share is

being sold.)

• It appears the owner of a provider is entering into a franchise agreement with a corporate

chain (and thus uses the chain’s name).

10.6.1.1.3.1.1 – Special Processing Instructions and Considerations for the

Initial Review Process

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

A. Form CMS-855A – Old and New Owner Applications

Unless stated otherwise in this chapter:

• The contractor shall ensure that all applicable sections of the Form CMS-855A for both the

old and new owner are completed in accordance with the instructions on the Form CMS-855A.

• The instructions in this section 10.6.1.1.3.1.1(A) apply only to the Form CMS-855A.

1. Previous Owner(s)

The previous owner’s Form CMS-855A CHOW application does not require a recommendation

for approval. Any recommendations will be based on the CHOW application received from the

new owner.

If the previous owner's Form CMS-855A is available at the time of review, the contractor shall

examine the information therein against the new owner’s Form CMS-855A to ensure consistency

(e.g., same names). If the previous owner's Form CMS-855A has not been received, the

contractor shall contact the previous owner and request it. However, the contractor may begin

processing the new owner’s application without waiting for the arrival of the previous owner’s

application. It may also make its CHOW recommendation to the state without having received

the previous owner’s Form CMS-855A.

If a certification statement is not on file for the individual signing the previous owner’s

application, the contractor shall request that the Individual Ownership and/or Managing Control

section of the Form CMS-855A be completed for said person.

Note that the previous owner’s Form CMS-855A CHOW application is essentially the equivalent

of a Form CMS-855A voluntary termination submission; this is because the old owner is

voluntarily leaving the Medicare program. As such, the contractor shall not require the old

owner to submit a separate Form CMS-855A voluntary termination along with its Form CMS-

855A CHOW application.

2. New Owner

If a Form CMS-855A is not received from the new owner within 14 calendar days of receipt of

the old owner’s Form CMS-855A, the contractor shall contact the new owner. If, within 30

calendar days after the contractor contacted it, the new owner fails to (1) submit a Form CMS-

855A and (2) indicate that it accepts assignment of the provider agreement, the contractor shall

send an e-mail to its PEOG BFL notifying the latter of the situation. PEOG will determine

whether the provider’s billing privileges should be deactivated under § 424.540(a)(2) or §

424.550(b) or revoked under § 424.535(a)(1) or (a)(9). PEOG will notify the contractor of its

decision.

In the situations described in the previous paragraph where the contractor is awaiting the new

owner’s application after received the old owner’s, the contractor shall: (1) begin processing the

old owner’s application; and (2) if possible, ascertain whether a CHOW has taken place.

3. Order of Processing of Old/New Owner Applications

To the maximum extent practicable, Form CMS-855A applications from the previous and new

owners in a CHOW should be processed as they arrive. However, unless the instructions in this

chapter indicate otherwise, the contractor should attempt to send the previous and new owners’

applications to the state simultaneously, rather than as soon as they are processed. For instance,

suppose the previous owner submits an application on March 1. The contractor should begin

processing the application immediately without waiting for the arrival of the new owner’s

application. Yet the contractor should avoid sending the previous owner’s application to the

state until the new owner’s application is processed. (For acquisition/mergers and consolidations

(as those terms are described on the Form CMS-855A), the contractor may send the applications

to the state separately.)

4. Form CMS-855A: CHOWs Involving Subtypes

a. Separate Reporting

Any subunit that has a separate provider agreement must report its CHOW on a separate Form

CMS-855A. It cannot report the CHOW via the main provider’s Form CMS-855A. If the

subunit does not have a separate provider agreement (e.g., hospital psychiatric unit), the CHOW

can be disclosed on the main provider’s Form CMS-855A; this is because the subunit is a

practice location of the main provider and not a separately enrolled entity.

b. Change in Subtype

A CHOW may occur in union with a change in the facility’s provider subtype. This can happen,

for instance, when a hospital undergoes a CHOW and changes from a general hospital to another

type of hospital, such as a psychiatric hospital. Although a change in hospital type is considered

a change of information (COI), the provider need not submit separate applications – one for the

COI and one for the CHOW. Instead, all information (including the change in hospital type)

should be reported on the CHOW application; the entire application should then be processed as

a CHOW (assuming it indeed qualifies as such). However, if the facility is changing from one

main provider type to another (e.g., hospital converting to a skilled nursing facility) and also

undergoing a CHOW, the provider must submit its application as an initial enrollment. The

contractor shall notify the provider of this and return the application.

(NOTE: For Medicare purposes, a critical access hospital (CAH) is a separately-recognized

provider type. Thus, a general hospital undergoing a CHOW while converting to a CAH must

submit its Form CMS-855A as an initial enrollment, not as a CHOW.)

5. Transitioning to Provider-Based Status (Form CMS-855A Submissions Only)

Consistent with existing CMS policy, a provider undergoing a CHOW pursuant to 42 CFR

§ 489.18 may be assigned to a new contractor jurisdiction only if the provider is

transitioning from freestanding to provider -based status. In such cases, the contractor for

the new jurisdiction (the “new contractor”) shall process both the old and new owner’s

Form CMS -855A applications. Should the “old/previous” (or current) contractor receive

the old and/or new owner’s Form CMS -855A applications, it shall (a) forward th e

application to the new contractor within 5 business days of receipt and (b) notify the new

contractor within that same timeframe that the application was sent.

B. Sales and Lease Agreements

Except as indicated otherwise, this subsection (B) applies to Form CMS-855A and Form CMS-

855B applications.

1. Verification of Terms

The contractor shall ascertain whether: (1) the sales/lease agreement includes the signatures of

the old and new owners, for the agreement must contain the signatures of both parties to the

transaction (if it does not, the contractor shall develop for an agreement containing both

signatures); (2) the information contained in the sales agreement is consistent with that reported

on the new owner's Form CMS-855A or the submitted Form CMS-855B (e.g., same names,

effective date); (3) the terms of the contract indicate that the new owner will accept assignment

of the provider agreement; and (4) the transaction falls within the scope of organizational

transactions covered under § 489.18 and this section 10.6.1.1 et seq.

(Note that a bill of sale/lease agreement/sales transfer agreement is a sales/lease business

document and should not be confused with a patient transfer agreement.)

A sales/lease agreement often will not specifically refer to the Medicare provider agreement,

assets, and liabilities. However, if (1) the box in the Change of Ownership (CHOW) Information

section of the Form CMS-855A is checked "Yes" and (2) the sales/lease agreement either

confirms that the new owner will accept assignment or is relatively silent on the matter, the

contractor can proceed as normal. If the agreement indicates that assignment will not be

accepted, however, the contractor shall follow the instructions in section 10.6.1.1.3.2(A) below.

As previously mentioned, any clarifying data must be furnished in writing (e.g., additional legal

documentation, letter, e-mail). If the clarification – for whatever reason - requires an update to

the supplier’s Form CMS-855 application, the contractor shall request the submission of said

update. In addition, if the contractor discovers discrepancies between the data in the sales

agreement and that on the Form CMS-855, the contractor shall seek clarifying information and,

if necessary, obtain an updated Form CMS-855.

2. Form of Sales/Lease Agreement

There are instances where the parties in a CHOW did not sign a “sales” or “lease” agreement in

the conventional sense of the term; the parties, for example, might have documented their

agreement via a “bill of sale.” The contractor can accept such documentation in lieu of a

sales/lease agreement so long as (1) the document addresses the transaction’s terms and (2) the

information in the agreement is consistent with that on the Form CMS-855 (as discussed above).

3. Submission of Sales/Lease Agreement

a. General Requirements – Unless specified otherwise in this chapter: (i) both the previous and

new owners in a Form CMS-855A CHOW situation must submit copies of the interim and final

sales/lease agreements; and (ii) copies of the interim and final sales/lease agreement must be

submitted in Form CMS-855B CHOW situations.

b. Forwarding to State - The contractor shall not forward a copy of the application to the state

until it has received and reviewed the final sales/lease agreement. However, the contractor need

not reverify the information on the Form CMS-855 while waiting for the final agreement, even if

the data therein may be somewhat outdated by the time the final agreement is received.

c. Failure to Submit - If a final sales/lease agreement is not submitted within 30 days after the

contractor’s receipt of the new owner’s application, the contractor shall reject the application.

Though the contractor must wait until the 30th day to reject the application, the contractor may

proceed with rejection regardless of how many times it contacted the new owner or what types of

responses (short of the actual receipt of the agreement) were received.

C. Relocation of Entity

A new owner may intend to relocate the provider concurrent with a CHOW. If the relocation is

to a site in a different geographic area serving different clients than previously served and

employing different personnel to serve those clients, the contractor shall notify the state via e-mail immediately. If the state believes that this situation has resulted in the effective creation of

a new provider, the contractor shall return the application and notify the new owner that a new,

initial enrollment application must be submitted. The provider must also notify the state or, if

applicable, accreditation agency.

D. Intervening Change of Ownership

In situations where the provider (1) submits a Form CMS-855 initial application or CHOW

application and (2) subsequently submits a Form CMS-855 CHOW application before the

contractor has finalized the first application, the contractor shall adhere to the following:

Situation 1 – The provider submitted an initial application followed by a CHOW application, and

a recommendation for approval to the state has not yet been made for the initial application: The

contractor shall return both applications and require the provider to re-submit an initial

application with the new owner’s information.

Situation 2 - The provider submitted a CHOW application followed by another CHOW

application, and a recommendation for approval to the state has not yet been made for the first

CHOW application: The contractor shall process both applications – preferably in the order they

were received – and shall, if recommendations for approval are warranted, refer both

applications to the state in the same package. The accompanying notice/letter to the state shall

explain the situation.

Situation 3 - The provider submitted an initial application followed by a CHOW application, and

a recommendation for approval of the initial application has been made to the state – The

contractor shall:

• Return the CHOW application.

• Notify the state via e-mail that a change of ownership has occurred (the new owner should be

identified) and that the contractor will require the new provider to resubmit a new initial

application containing the new owner’s information.

• Request via letter that the provider submit a new initial Form CMS-855 application

containing the new owner’s information within 30 days of the date of the letter. If the

provider fails to do so, the contractor shall return the originally submitted initial application

and notify the provider and the state of this via letter. If the provider submits the requested

application, the contractor shall process it as normal and, if a recommendation for approval is

made, send the revised application package to the state with an explanation of the situation;

the originally submitted initial application becomes moot. If the newly submitted/second

initial application is denied, however, the first submitted application is denied as well; the

contractor shall notify the provider and the state accordingly.

Situation 4 - The provider submitted a CHOW application followed by another CHOW

application, and a recommendation for approval has been made for the first application - The

contractor shall:

• Notify the state via e-mail that (1) a subsequent change of ownership has occurred (the new

owner should be identified) and (2) the contractor will require the provider to resubmit a new

CHOW application containing the subsequent/second new owner’s information.

• Process the new/second CHOW application as normal. If a recommendation for approval is

made, the contractor shall send the revised CHOW package to the state with an explanation

of the situation; the first CHOW application becomes moot. If the newly submitted/second

CHOW application is returned per section 10.6.1.1.3.2 below, the first application should,

too, be returned. The contractor shall notify the provider and the state accordingly.

E. Potential CHOW

On occasion, a provider or supplier submits a Form CMS-855 change of information to report a

large-scale stock transfer or other significant ownership change that the provider does not believe

is (or report as) a CHOW. If the contractor suspects that the transaction in question might indeed

be a CHOW, it shall request clarifying information (e.g., copy of the stock transfer agreement).

F. Entry into PECOS - Paper Applications Only

If it appears that the new owner will be accepting assignment and that the transaction falls within

the scope of § 489.18, the contractor shall enter the CHOW information into the new enrollment

record that shall be created for the new owner. (If the state recommends approval of the CHOW

(see section 10.6.1.1.3.3 below), the Part A provider’s CCN will be maintained in the new

owner’s enrollment record once the record is switched to an approved status.)

A new enrollment record must be created if a new TIN is established pursuant to the CHOW.

(For PECOS applications, PECOS will automatically perform the enrollment record activities

described in this subsection (F).)

10.6.1.1.3.2 – Step 2 – Post-Initial Review Actions and Scenarios

(Rev. 11125; Issued 11-18-21; Effective: 12-03-21; Implementation: 01-03-22)

After the contractor completes the tasks in section 10.6.1.1.3.1, several results are possible.

These are discussed below. Should the contractor encounter a scenario not addressed herein, it

may contact its PEOG BFL for guidance. As a reminder, nothing in section 10.6.1.1.3.2

prohibits the contractor from returning or rejecting the application if otherwise permitted to do so

per this chapter.

A. Scenarios

1. The contractor ascertains that the transaction falls within the scope of § 489.18 and that the

new owner has accepted assignment – If there are no apparent grounds for denying the

application (e.g., the new owner has a felony conviction, false information was submitted, a

newly reported chief executive officer is excluded), the contractor shall make a recommendation

for approval to the state consistent with existing practice and via existing means. (This includes

sending recommendations via hard copy mail if the state only accepts this method of

transmission.) If a denial ground exists, however, the contractor shall refer the matter to its

PEOG BFL for guidance before submission to the state, notwithstanding any other instruction in

this chapter to the contrary. The contractor should include an explanation of the ground(s) it

believes exists for the denial (including the regulatory citation).

(For Form CMS-855B CHOW applications: Note that an approval recommendation can be made

(and must be treated as a CHOW) notwithstanding the general rule that a TIN change constitutes

an initial enrollment; in other words, the reporting rules regarding CHOWs/assignments in this

particular situation take precedence over the “change of TIN” principle.)

2. The contractor ascertains that the transaction falls within the scope of § 489.18 but the new

owner has not accepted assignment – The contractor shall:

(a) return the application; and (b) notify the new owner in the return letter that it must submit the

following within 30 days from the date of the return letter: (i) an initial Form CMS-855

application to enroll as a new provider; and (ii) a voluntary termination application for the

existing provider. If the new owner fails to do so within 30 days of the request, the contractor

shall contact its PEOG BFL via e-mail with this information notwithstanding any other

instruction to the contrary in this chapter. PEOG will review the matter and respond to the

contractor.

3. The contractor ascertains that the transaction does not fall within the scope of § 489.18 (e.g.,

stock transfer), regardless of whether the new owner accepted assignment - This qualifies as an

ownership change under 42 CFR § 424.516 rather than a CHOW under § 489.18. The contractor

shall: (a) return the application; and (b) notify the provider in the return letter that it must submit

a Form CMS-855 application to report the ownership change within 30 days of the return letter.

If the provider fails to do so, the contractor shall contact its PEOG BFL via e-mail with this

information notwithstanding any other instruction to the contrary in this chapter.

(The only exception to the policies in the previous paragraph is if (1) the submission is a Form

CMS-855B and (2) the § 424.516 ownership change also involves a change of TIN. In this

scenario, the contractor shall: (a) return the application; and (b) notify the supplier in the return

letter that it must submit the following within 30 days from the date of the return letter: (i) an

initial Form CMS-855B application to enroll as a new supplier; and (ii) a voluntary termination

application. If the supplier fails to do so, the contractor shall contact its PEOG BFL the

contractor shall contact its PEOG BFL via e-mail with this information notwithstanding any

other instruction to the contrary in this chapter.

B. Referral to State

If the contractor believes that a recommendation for approval per section 10.6.1.1.3.2(A)(1) is

warranted, it shall send a recommendation letter to the state (with a copy to the accreditation

organization (AO), if applicable). The letter shall follow the format of existing model CHOW

recommendation letters in section 10.7 et seq. of this chapter. (Neither the SOG Location nor

PEOG need be copied on the letter.) The CHOW package shall: (1) be sent to the state in a

manner consistent with existing and past practice; and (2) contain all the applicable documents

described in section 10.6.1.1.3.1(A)(iii) above. (For instance, the package must include, among

other things, the CMS-377 for ASC and the CMS-3427 for ESRD facilities.)

The state will: (1) review the package for completeness; (2) review the contractor’s

recommendation for approval; (3) perform any state-specific functions; and (4) contact the

contractor with any questions. The contractor shall respond to any state inquiry in Item (4)

within 5 business days. If the inquiry involves the need for the contractor to obtain additional

data, documentation, or clarification from the provider, however, the timeframe is 15 business

days; if the provider fails to respond to the contractor within this timeframe, it shall notify the

state thereof. The contractor may always contact its PEOG BFL should it need the latter’s

assistance with a particular state inquiry.

10.6.1.1.3.3 – Step 3 – Post-State Review Actions and Scenarios

(Rev. 11432; Issued: 05-26-22; Effective: 05-27-22; Implementation: 05-27-22)

The state will notify the contractor once it has completed the tasks identified in section

10.6.1.1.3.2(B) above (normally within 90 days of receiving the package from the contractor). In

general, there are two potential outcomes:

A. Approval Not Recommended

If the state does not recommend approval, it will notify the contractor thereof. The contractor

may accept the notification so long as it is in writing (e-mail is fine). No later than 5 business

days after receiving this notification, the contractor shall send an e-mail to

MedicareProviderEnrollment@cms.hhs.gov with the following information and documents: (1)

the Form CMS-855 application or PECOS Application Data Report; (2) a copy of the final

sales/transfer agreement; and (3) a copy of the Form CMS-1539 or similar documentation

received from the state. PEOG will review the matter, perform any administrative functions, and

respond to the contractor with applicable direction.

B. Approval Recommended

If the state recommends approval, it will typically (though not always) do so via a Form CMS-

1539; the contractor may accept any documentation from the state signifying that the latter

recommends approval. (Note that the contractor will not receive a tie-in or tie-out notice, neither

of which are issued any longer for CHOWs.)

No later than 5 business days after receipt of the recommendation, the contractor shall send an e-mail to MedicareProviderEnrollment@cms.hhs.gov with the following information and

documents: (1) the Form CMS-855 application (or PECOS Application Data Report) and all

application attachments; (2) a copy of the final sales/transfer agreement; (3) a copy of the Form

CMS-1539 or similar documentation received from the state; (4) a copy of the provider-signed

Form CMS-1561/1561A/370 (as applicable); (5) a copy of the Form HHS-690; and (6) a copy of

the draft approval letter, with the effective date shown on the Form CMS-1539 (or similar

documentation) included in the draft letter. PEOG will countersign the provider agreement,

assign an effective date of the CHOW based on the information received from the contractor, and

approve the draft letter (with possible edits).

Within 5 business days of receiving from PEOG the signed provider agreement and effective

date, the contractor shall: (1) send the CHOW approval letter and a copy of the CMS-countersigned provider agreement to the provider (with a copy to the AO, if applicable); and (2)

switch the PECOS record from “approval recommended” to “approved” consistent with existing

instructions.