Listed below are the 6 most common reasons a Provider Enrollment application process is delayed.

• Section 15 (Certification Statement) of the CMS 855A is not signed and dated or is not signed by the appropriate official. Section 15 must be signed by an authorized official to whom the organization has granted the legal authority to enroll it in the Medicare program, to make changes and/or updates to the organization status in the Medicare program, and to commit the organization to fully abide by the laws, regulations, and program instructions of Medicare. The authorized official must be the organizations general partner, chairman of the board, chief financial officer, chief executive officer, or president, or must hold a position of similar status and authority within the organization. This person also must be listed in Section 6 of the CMS 855A application
   
• Requesting a completed CMS 855A application. A CMS 855A application must be completed by all organizations that will be billing Medicare Intermediaries for medical services. This form must be completed if an address, pay to address, authorized official or a telephone number has changed. Also, if a Change of Ownership has occurred you must complete a CMS855A. If a tax id number has changed an 855A must be submitted as if the organization has had a change of ownership. All changes must be reported to the fiscal intermediary within 90 days of the effective date of change. However, changes may be reported, via filing of the 855A, up to 90 days prior to the effective date of the change. This enables processing to be completed more closely to the effective date.
   
• Section 6 of the CMS 855A application is not completed. Section 6 of the CMS 855A application requests information on individuals that have ownership interest and/or managing control in the enrolling organization. All officers, directors, and managing employees of the organization must complete this section. All fields of this section must be completed for each individual that is listed.
   
• Requesting copies of the following information:
  State, Federal, local (city/county) professional/business licenses, certifications and/or registrations specifically required to operate as a health care facility; adverse legal action documentation; signed EDI or EFT agreements (if applicable); partnership agreements; articles of incorporations; sales agreements (2 copies); CP575; any other letters of explanation as needed.
   
• Requesting a CP575. A CP575 must be submitted with the CMS 855A application. The CP575 is the official letter from the IRS confirming the tax identification number with the legal business name. If the CP575 is not available, we will also accept a copy of the quarterly tax payment coupon or any official letter from the IRS that lists the legal business name and tax id number.
   
• Requesting CMS 855A regarding a CHOW. A CMS 855A must be completed by the current owner (seller/old owner). The current owner must check the Change of Ownership box in Section 1A1, then complete Section 1A2, 1A3 and Section 1B, and sign and date the Certification Statement in Section 15.