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It has come to our attention, that a great many facilities
are making changes within their organizations without reporting
them to their Medicare Part A Fiscal Intermediary. Many of
these changes should be reported to Medicare through a CMS
855A.
FAQ among the provider community:
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Is there a time line to complete
changes to Medicare?
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If we have not reported these changes to Medicare
and then realize we should have, is there a penalty?
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Can you provide a listing of changes that
are necessary to be reported on an 855A?
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I have already submitted an 855A in its entirety
and only one item has changed. Do I need to submit another
complete form?
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What needs to be done to submit a CMS 855A
change of information?
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Where do I file my CMS 855A?
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Do you have a contact that I can call to help
me with questions concerning enrollment?
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Do I need to complete an enrollment application,
CMS 855A, when requesting Electronic Funds Transfers?
Question 1:
Is there a time line to complete changes to Medicare?
Answer: Per the CMS 855A instructions
for Section 1 – General Application Information; Change
of Information “All changes must be reported to the fiscal
intermediary within 90 days of the effective date of the change.” However,
any changes that are made within an organization are best disclosed
as quickly as possible. This keeps the files updated with the
most current information and assists in enabling Medicare to
get any information to you in a timely manner.
Question 2:
If we have not reported these changes to Medicare and then
realize we should have, is there a penalty?
Answer: No. However you should
notify us as soon as possible after you discover the omission.
Question 3:
Can you provide a listing of changes that are necessary to
be reported on an 855A?
Answer: Please find below a list
of the major changes that must be reported to your Medicare
Part A Fiscal Intermediary. This list is not all inclusive.
Changes of address: This should be done whether the change
is to the “physical” location of the facility or
to the “correspondence” address.
Changes of “Pay to Address”: If you decide that
you want to use “EFT”, change a banking institution,
change a bank #, etc…
Change of Administrator, CFO, CEO, and any individual that
has at least a 5% interest in the organization, owners, Director/Officer,
partners, & managing employees. (This must be done whether
you are adding, deleting or changing the above information.)
· Changes in the Authorized Official or the Delegated Official/s.
· Changes in the Contact Person.
· Changes in your Billing Agency information.
· Changes within your Chain Home Office Information.
Again, the above list is not all inconclusive; there may be
other changes that need to be reported via the CMS 855A Enrollment
Form.
Question 4:
I have already submitted an 855A in
its entirety and only one item has changed. Do I need to submit
another complete form?
Answer: If you have already filed
an entire CMS 855A, you need only complete the sections in
which the changes have occurred.
If you have never filed a CMS 855A, we request that you fill
out the entire form. You may request these forms from your
Fiscal Intermediary or by obtaining a copy from the website
located at:
www.cms.gov/providers/enrollment/forms
Question 5:
What needs to be done to submit a CMS 855A change of information?
Answer: Every change that is
reported via the CMS 855A should be started by completing:
Section 1 General Application Information, as per the instructions
contained in Section 1:
“To ensure timely processing of this application, Numbers 1 and 2 MUST
ALWAYS be completed.”
Continue by completing all sections in which you have requested
changes be made. All of the above changes must be accompanied
by a “Section 15 = Authorized Official Signature page” or
the Section 16 = Delegated Official. The Authorized Official
must sign Section 15 for the “Initial” enrollment
of the provider. The Delegated Official may sign Section 15
for changes made after initial enrollment.
Please note that a provider may have only one Authorized Official
and up to three Delegated Officials.
Question 6:
Where do I file my CMS 855A?
Answer: When you have completed
all the relevant sections, mail the CMS 855A to:
Blue Cross Blue Shield of Arizona
Medicare Provider Enrollment
P.O. Box 37700
Phoenix AZ 85069-7700
If you are sending via overnight delivery, please send the
application to:
Blue Cross Blue Shield of Arizona
Medicare Provider Enrollment
2331 W. Royal Palm Road, Ste 115
Phoenix, AZ 85021
Question 7:
Do you have a contact that I can call to help me with questions
concerning enrollment?
Answer: Yes. You may contact
Sharon Hudson at 602-864-4225 or by writing to her at the above
address.
Question 8:
Do I need to complete an enrollment application, CMS 855A,
when requesting Electronic Funds Transfers?
Answer: Yes and No.
Per the Program Integrity Manual, if the provider has never
submitted an 855A, then the provider is required to complete
an 855A in its entirety prior to being eligible to receive
funds via EFT. The signatures on the 855A and the EFT form
(CMS 588) must agree.
If the provider has submitted an 855A previously, then the
provider does not have to complete a new application. However,
the person signing the EFT form must be the current authorized
or delegated official.
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