CMS Pub. 100-08, ch. 10, § 10.6.1.1.4

Except as otherwise stated, the instructions in this section 10.6.1.1.4 apply to the Form CMS-

855A and Form CMS-855B.

A. Payment Changes - In a CHOW, the contractor shall continue to pay the old owner until it

receives from PEOG the e-mail, effective date, and signed provider agreement referenced

in Section 10.6.1.1.3.3(B). Hence, any application from the old owner or new owner to change

the EFT account or special payment address to that of the new owner shall be returned. It is

ultimately the responsibility of the old and new owners to coordinate any payment arrangements

between themselves while the contractor and the state are reviewing the CHOW. It is

recommended that the contractor notify the new owner of this while processing the application.

B. National Provider Identifiers (NPI) - Depending on the sale’s terms, the new owner may

obtain a new NPI or maintain the existing NPI. Once CHOW processing is complete, the old

owner is prohibited from billing for services (i.e., services furnished after CHOW processing is

complete); only the new owner may submit claims using the existing CCN. As already stated,

the old owner and new owner must arrange between themselves any payment matters regarding

claims for services furnished during the CHOW processing period.

C. CHOW Pre-Approval Changes of Information

1. Old Owner

If – prior to receiving an approval recommendation from the state -– the contractor receives from

the old owner a Form CMS-855 request to change any of the provider’s enrollment data, the

contractor shall return the change request if the information involves changing the provider’s:

i. EFT or special payment address information to that of the new owner (as described in section

10.6.1.1.4(A) above);

ii. Practice location or base of operations to that of the new owner;

iii. Ownership or managing control to that of the new owner;

iv. Legal business name, TIN, or “doing business as” name to that of the new owner.

All other “pre-state recommendation” Form CMS-855 change requests from the old owner can

be processed normally.

2. New Owner

If – prior to receiving an approval recommendation from the state - the contractor receives from

the new owner a Form CMS-855 request to change any of the provider/supplier’s existing

enrollment information, the contractor shall return the change request. This is because the old

owner remains the owner of record at this time; the new owner therefore has no standing to

submit Form CMS-855 changes on behalf of the provider.

D. Change of Transaction Type in PECOS - There may be instances where the contractor

enters a transaction into PECOS as a CHOW, but it turns out that the transaction was not a

CHOW (e.g., was a stock transfer; was an initial enrollment because the new owner refused to

accept assignment). If the contractor cannot change the transaction type in PECOS, it can leave

the record in a CHOW status; however, it should note in PECOS that the transaction was not a

CHOW.

E. Unreported CHOW - If the contractor learns via any means (including from the state or

SOG Location) that an enrolled provider has been purchased by another entity or has purchased

another Medicare-enrolled provider, the contractor shall immediately request Form CMS-855A

CHOW applications from both the previous and new owners (or request a Form CMS-855B

CHOW application from the ASC or PXRS). If the new owner fails to submit a Form CMS-855

within the latter of (1) the date of acquisition or (2) 30 days after the request, 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.

F. Precise Time of CHOW - In general, a Medicare CHOW is considered to have taken place

at 12:01 a.m. on the date specified (i.e., in the first minute of the 24-hour day). Legal

responsibility and the right to payment changes when the clock moves past midnight into the

CHOW effective date.

G. Termination of CCN - If the new owner rejects assignment, the CCN associated with that

agreement (the old owner’s) also terminates on the date of the ownership transfer.

H. Clock Stoppages and Processing Alternatives - While awaiting PEOG’s reply on any

matter in this section 10.6.1.1 et seq. in which the contractor is required to refer a matter to

PEOG - and beginning on the date following the sending of the e-mail referenced therein - the

application processing time clock is stopped. It resumes on the date on which the contractor

receives PEOG’s final response. Communication between the contractor and PEOG during this

“waiting period” (e.g., PEOG request for additional information from the contractor) does not

restart the clock.

In addition, nothing in this section 10.6.1.1 et seq. negates other permissible clock stoppages and

processing alternatives outlined in this chapter that can apply to the applications addressed in this

section 10.6.1.1 et seq.