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Before You Submit A CMS Form 855A

Before You Submit A CMS Form 855A

You must have a National Provider Identifier (NPI). An NPI is required for a change of information, change of ownership or to apply for a new Medicare number. Your application will be delayed if you fail to provide an NPI with your original submission. Applyfor an NPI.   If you need additional information regarding the NPI, you many contact the enumerator company, (Fox Systems) directly at 1-800-465-3203 or at customerservice@npienumerator.com

You must agree to accept Electronic Payment. This federally-mandated requirement applies to established providers submitting a change of information or change of ownership that are not already set up for electronic payment, as well as all new enrollees. An Electronic Funds Transfer Authorization Agreement (EFT) form must be included with your application request. Your application will be delayed if you fail to include a completed EFT Agreement with your original submission. See below for additional details.

Providers' Responsibilities in the Enrollment Process:

Providers are responsible for submitting a complete and accurate enrollment application. You must comply with all the directions on the enrollment applications. Incomplete or inaccurate applications cannot be processed.

Providers who submit an incomplete application will be contacted within approximately 15 days to request the missing items required to complete processing. Failure to respond timely to this request for information will result in the application being rejected. To reapply, the provider will need to complete an entirely new application and start the process over.

Please know that it can take up to 180 days to complete applications that are submitted with incomplete or inaccurate information.

*** Please do not call the Provider Enrollment Department to check the status of your application. This will not expedite your application. ***