CMS Pub. 100-08, ch. 10, § 10.6.23

and Special Payment Addresses

(Rev. 11682; Issued: 11-04-2022; Effective: 12-05-2022; Implementation:12-05-2022)

(The instructions in this section 10.6.23 take precedence over all other contrary instructions in

this chapter, including, but not limited to, the existing guidance in sections 10.3.1.1.4, 10.3.1.2.4,

and 10.3.1.3.4. The policies in this section will eventually be incorporated into the sections of

this chapter that are applicable to the subject matter.)

A. Enrolled Providers/Suppliers

1. General Policy

A provider/supplier may only have one EFT account and one special payment address (SPA) per

enrollment. As a general rule, multiple EFT accounts or SPAs within an existing enrollment will

remain in effect only until the provider/supplier submits any update to its EFT information or

SPA data, respectively, for any of these accounts or addresses. At that time, the EFT account or

SPA for which the provider/supplier submitted the update will become the lone EFT account or

SPA (as applicable) for that enrollment.

For purposes of this requirement:

(i) The term “enrollment” means a single enrollment in a single state involving a single

provider/supplier type. The particular PTAN arrangement under the enrollment (e.g., a group

practice has three practice locations under its Form CMS-855B enrollment, each with a separate

PTAN) is irrelevant for purposes of this requirement; again, the requirement is based on the

enrollment, not the PTAN.

(ii) Any submitted change to any of the provider/supplier’s EFT or SPA data for any EFT

account or SPA within an enrollment --- even a change that the provider/supplier did not cause

(e.g., a government-generated zip code change) and even if it is for only one of the enrollment’s

EFT accounts or SPAs --- triggers the aforementioned requirement. The materiality of the

change does not matter. However, the changed data must have actually been submitted via the

appropriate CMS form to invoke the requirement; using the example in the previous sentence,

this zip code change would not trigger the requirement unless and until the provider/supplier

reports it via a CMS form.

(iii) If the provider/supplier reports the changed EFT or SPA data as part of a revalidation,

reactivation, or other enrollment transaction other than a change of information (COI), the

requirement is invoked to the same extent as with a COI.

(iv) The requirement applies only to the precise enrollment (e.g., “Enrollment A”) for which the

change was submitted. It is inapplicable to the provider/supplier’s other enrollments

(“Enrollments B and C”), even if B and C have:

• Multiple EFT accounts or SPAs that match those for which the provider/supplier reported

a change to its “Enrollment A” EFT or SPA data; and/or

• The same LBN or TIN as “Enrollment A.”

(v) A change in EFT data does not invoke the need to “consolidate” the provider/supplier’s SPAs

if the provider/supplier has multiple SPAs; likewise, a change in SPA data does not require the

“consolidation” of the provider/supplier’s multiple EFT accounts. (For purposes of this section

10.6.23, the term “consolidate” simply means reducing the provider/supplier’s multiple EFT

accounts or SPAs to one.)

(vi) Even if the multiple EFT accounts are with the same banking institution, the aforementioned

“consolidation” requirement applies.

(vii) Any EFT and/or SPA consolidation under this section 10.6.23 applies to all PTANs under

the single enrollment.

(viii) The consolidation requirement applies irrespective of whether the EFT or SPA change that

the provider/supplier submitted is approved, denied, rejected, or returned.

(ix) The term “multiple” EFT accounts or SPAs only applies to active EFT accounts/SPAs.

(x) Except as otherwise noted, any consolidation described in this section 10.6.23 becomes

effective on the date of the applicable approval, denial, rejection, or return letter (see subsection

(A)(2)(i) below).

Consider the following:

EXAMPLE – Provider X is enrolled as a group practice and a HIT supplier (i.e., two separate

enrollments) in State Y. Currently:

• The group practice enrollment has two EFT accounts (one with Smith Bank and one with

Jones Bank) and two SPAs (1 James Street and 200 Johnson Street)

• The HIT supplier enrollment has the same two EFT accounts and SPAs as the group

practice

Provider X submits a change to its Smith Bank account information for the group practice

enrollment. In this scenario: (1) the Smith Bank account becomes the lone EFT account for

the group practice; (2) the group practice’s Jones Bank account becomes inactive in PECOS

effective on the date of the notice to the provider/supplier that the originally submitted EFT

or SPA change was approved, denied, etc. (see subsection (A)(2)(i) below); (3) the Smith

Bank and Jones Bank accounts for the HIT supplier enrollment are unaffected; and (4) the

SPAs for Provider X’s two enrollments are unaffected.

2. Operational Procedures

If the contractor receives an EFT or SPA change and determines that the provider/supplier has

multiple EFT accounts or SPAs (as applicable and consistent with the guidelines described in

subsection (A) above) for that enrollment, the contractor shall follow the procedures described

below. (The example in subsection (A) will be used as a format.)

Step 1 – The contractor shall process the EFT data change for the group practice’s Smith Bank

account as normal.

Step 2 – Upon final completion of its processing of the change, the contractor shall:

i. Send the appropriate approval, denial, etc., letter to the provider/supplier consistent with the

instructions in this chapter. The contractor shall, however, add the following language to the

letter:

“Under CMS policy, a Medicare provider or supplier may only have one [“EFT account” or

“special payment address”, as applicable] per enrollment. Consistent therewith, [Contractor

name] has designated the [“EFT account” or “special payment address”, as applicable] for which

you reported changed [“EFT” or “special payment address”] information as the sole [“EFT

account” or “special payment address”] for this enrollment. This designation is effective as of

the date of this letter. All payments previously sent to your other [“EFT account(s)” or “special

payment address(es)”] under this enrollment will now be made to the sole designated [“EFT

account” or “special payment address”] described above. If you wish to change this sole

designated [“EFT account or “special payment address”], you must submit the applicable [Form

CMS-588, Form CMS-855, or Form CMS-20134, as applicable] to do so.

Note that the sole designation described above applies only to the enrollment for which you

submitted the requested change to your [“EFT” or “special payment address’] data. It is

inapplicable to any other enrollments you have.”

The contractor may: (1) notwithstanding any other instruction to the contrary in section 10.7 et

seq. of this chapter, alter the forgoing language to conform to the provider/supplier’s particular

factual situation (prior CMS approval is unnecessary); and (2) insert said language in any part of

the letter it chooses.

ii. End-date the “other” EFT account(s) or SPA(s) (as applicable) effective the date of the letter

described in subsection (A)(2)(i) above. The contractor shall make all payments under the

enrollment to the sole account/SPA beginning the day after the date of the letter.

iii. Apply the PTAN(s) associated with the deleted EFT account/SPA to the sole EFT

account/SPA.

iv. Complete all other normal steps required under this chapter for finalizing the transaction in

question.

B. Providers/Suppliers Initially Enrolling or Undergoing a CHOW Consistent with

Principles of 42 CFR § 489.18

The aforementioned policy that a provider/supplier may only have one EFT account and one

SPA per enrollment also applies to: (1) providers/suppliers submitting an initial enrollment

application; and (2) new owners in a certified provider/supplier CHOW (i.e., a CHOW consistent

with the principles of § 489.18). The contractor shall apply this policy to such applications. If,

therefore, the provider/supplier/new owner submits the application with more than one EFT

account or SPA, the contractor shall develop for a single EFT account or SPA (as applicable)

consistent with the instructions in this chapter. If the provider/supplier/new owner fails to

comply within 30 days, the contractor shall reject the application pursuant to 42 CFR §

424.525(a)(1).