100-08 Medicare Program Integrity Manual: Chapter 15 - Medicare Enrollment

Medicare Program Integrity Manual
Chapter 15 - Reserved for Future Use
Table of Contents
(Rev. 10945, 08-12-21)
Transmittals for Chapter 15

Transmittals Issued for this Chapter
Rev # 	Issue Date 	Subject 	Impl Date CR#
R10945PI 08/12/2021 Removal of Provider Enrollment Policy
from Chapter 15 in Publication (Pub.)
100-08
09/13/2021 12391
R10723PI 04/08/2021 Implementation of Provider Enrollment
Provisions in CMS-6058-FC – Phase 1 –
Continued Removal/Moving of
Instructions from Chapter 15 of
Publication (Pub.) 100-08 to Chapter 10
of Pub. 100-08
08/10/2020 11551
R10611PI 03/19/2021 Completion of Removal/Moving of
Instructions from Chapter 15 of
Publication (Pub.) 100-08 to Chapter 10
of Pub. 100-08
11/19/2020 11917
R10524PI 12/17/2020 Chapter 15 of Publication (Pub.) 100-08
Manual Redesign – Additional Release of
Chapter 10
11/13/2020 11700
R10383PI 10/09/2020 Updates to Chapters 4, 5, 8, 15, and
Exhibits of Publication (Pub.) 100-08
11/10/2020 11999
R10355PI 09/18/2020 Completion of Removal/Moving of
Instructions from Chapter 15 of
Publication (Pub.) 100-08 to Chapter 10
of Pub. 100-08- Rescinded and replaced
by transmittal 10611
11/19/2020 11917
R10353PI 09/11/2020 Chapter 15 of Publication (Pub.) 100-08
Manual Redesign – Additional Release of
Chapter 10 of Pub. 100-08, Modification
of the Timeliness Standards
02/01/2021 11865
R10345PI 09/11/2020 Chapter 15 of Publication (Pub.) 100-08
Manual Redesign – Additional Release of
Chapter 10- Rescinded and replaced by
transmittal 10524
11/13/2020 11700
R10239PI 07/28/2020 Implementation of Provider Enrollment
Provisions in CMS-6058-FC – Phase 1 –
Continued Removal/Moving of
Instructions from Chapter 15 of
Publication (Pub.) 100-08 to Chapter 10
of Pub. 100-08- Rescinded and replaced
by Transmittal 10723
08/10/2020 11551

Rev # 	Issue Date 	Subject 	Impl Date CR#
R10182PI 06/15/2020 Update to Chapter 10 of Publication
(Pub.) 100-08 - Model Letter Templates
09/16/2020 11375
R10146PI 05/22/2020 Implementation of Provider Enrollment
Provisions in CMS-6058-FC – Phase 1 –
Continued Removal/Moving of
Instructions from Chapter 15 of
Publication (Pub.) 100-08 to Chapter 10
of Pub. 100-08- Rescinded and replaced
by Transmittal 10239
07/24/2020 11551
R10138PI 05/15/2020 Moving Chapter 15 (Medicare
Enrollment) Manual Instructions in
Publication (Pub.) 100-08 to Chapter 10
(Medicare Enrollment)
06/16/2020 11546
11/22/2019 Additional Guidance on Private
Contracting/Opting-out of Medicare and
Entering Opt-out Affidavit Records in the
Provider Enrollment, Chain and
Ownership System (PECOS)
12/24/2019 10939
R904PI 	09/27/2019 Provider Enrollment Rebuttal Process 	12/31/2019 10978
R902PI 	09/27/2019 Updates to Chapters 3, 4, 8, 15, and
Exhibits of Publication (Pub.) 100-08
10/28/2019 11425
R898PI 	09/06/2019 Updates to Provider Enrollment
Processing Instructions in Chapter 15 of
Publication (Pub.) 100-08, Program
Integrity Manual, and to the CMS-855R
Processing Guide
10/07/2019 11371
R896PI 	08/30/2019 Updates to Provider Enrollment
Processing Instructions in Chapter 15 of
Publication (Pub.) 100-08
10/01/2019 11325
R882PI 	05/24/2019 Additional Processing Procedure for
Adding a New Provider-Based Location
for Critical Access Hospitals (CAHs)
06/25/2019 11246
R865PI 	02/21/2019 Update to Chapter 15 of Publication
(Pub.) 100-08
03/12/2019 10954
R862PI 	02/08/2019 Update to Chapter 15 of Publication
(Pub.) 100-08- Rescinded and replaced
03/12/2019 10954

Rev # 	Issue Date 	Subject 	Impl Date CR#
by Transmittal 865
R824PI 	09/052018 	Update to Chapter 15 of Publication
(Pub.) 100-08, Certification Statement
Policies
10/01/2018 10845
R822PI 	08/24/2018 Update to Chapter 15 of Publication
(Pub.) 100-08, Certification Statement
Policies- Rescinded and replaced by
Transmittal 824
10/01/2018 10845
R797PI 	06/01/2018 Reviewing for Adverse Legal Actions
(ALA)
04/30/2018 10558
R762PI 	04/30/2017 Update to Chapter 15 of Pub. 100-08 	01/29/2018 10386
R782PI 	03/30/2018 Update to Chapter 15 of Publication 100-
08 - Medicare Enrollment Deactivation
Policies
04/30/2018 10443
R784PI 	03/30/2018 Reviewing for Adverse Legal Actions
(ALA)
04/30/2018 10558
R773PI 	02/23/2018 Form CMS-855O Processing Guide 	03/23/2018 10355
R765PI 	01/08/2018 Medicare Diabetes Prevention Program
(MDPP) Enrollment Process
01/19/2018 10356
R734PI 	07/28/2017 Update to Reporting Requirements 	06/27/2017 9924
R719PI 	05/26/2017 Update to Reporting Requirements 	06/27/2017 9924
R718PI 	05/19/2017 Reviewing for Adverse Legal Actions
(ALA)
06/20/2017 9879
R717PI 	05/12/2017 Update to Pub. 100-08, Chapter 15 	05/15/2017 9953
R715PI 	05/11/2017 Update to Pub. 100-08, Chapter 15 	06/13/2017 9953
R711PI 	04/25/2017 Update to Pub. 100-08, Chapter 15 	05/15/2017 9953
R710PI 	04/14/2017 Update to Pub. 100-08, Chapter 15 	05/15/2017 9953
R689PI 	12/09/2016 Clarification of Certification Statement
Signature and Contact Person
Requirements
01/09/2017 9776
R688PI 	11/18/2016 Update to Pub. 100-08, Chapter 15 	07/26/2016 9635
R685PI 	11/03/2016 Incorporation of Cycle 2 Revalidation
Policies
09/06/2016 9628
R684PI 	11/01/2016 Incorporation of Cycle 2 Revalidation
Policies – Rescinded and replaced by
Transmittal 685
12/02/2016 9628
R681PI 	10/27/2016 Revision to Surety Bond Collection 	01/30/2017 9755

Rev # 	Issue Date 	Subject 	Impl Date CR#
Procedures
R676PI 	09/16/2016 Clarification of Certain Policies in Pub.
100-08, Chapter 15 Regarding the
Processing of Form CMS-855R
Applications
12/19/2016 9552
R666PI 	08/05/2016 Incorporation of Cycle 2 Revalidation
Policies - Rescinded and replaced by
Transmittal 684
09/06/2016 9628
R659PI 	06/24/2016 Update to Pub. 100-08, Chapter 15 -
Rescinded and replaced by Transmittal
688
07/26/2016 9635
R636PI 	02/04/2016 Update to Pub. 100-08, Chapter 15 	03/04/2016 9390
R626PI 	11/13/2015 Update to Surety Bond Collection
Requirements
12/14/2015 9296
R609PI 	08/14/2015 Clarification Regarding the Processing of
Certain Provider Enrollment-Related
Transactions
11/02/2015 9174
R605PI 	07/31/2015 Clarification Regarding the Processing of
Certain Provider Enrollment-Related
Transactions – Rescinded and replaced by
Transmittal 609
11/02/2015 9174
R592PI 	05/08/2015 Update of Provider Enrollment
Instructions in Chapter 15 of Pub. 100-08
06/08/2015 9139
R591PI 	05/08/2015 Revisions to Surety Bond Collection
Policies
06/08/2015 9123
R590PI 	04/24/2015 Update of CMS-855A, Physician-Owned
Hospital Reporting Via the CMS-
855POH and Indirect Payment Procedure
Registration Via the CMS-855C in
Chapter 15 of Pub. 100-08
05/25/2015 9120
R587PI 	04/17/2015 Clarification of Ordering and Certifying
Documentation Maintenance
Requirements
07/20/2015 9112
R582PI 	03/04/2015 Incorporation of Certain Provider
Enrollment Policies in CMS-6045-F into
Pub. 100-08, Program Integrity Manual
(PIM), Chapter 15
05/28/2015 9065
R581PI 	02/27/2015 Incorporation of Certain Provider
Enrollment Policies in CMS-6045-F into
Pub. 100-08, Program Integrity Manual
05/28/2015 9065

Rev # 	Issue Date 	Subject 	Impl Date CR#
(PIM), Chapter 15 – Rescinded and
replaced by Transmittal 582
R578PI 	02/25/2015 Incorporation of Revalidation Policies
into Pub. 100-08, Program Integrity
Manual (PIM), Chapter 15
05/15/2015 9011
R575PI 	02/13/2015 Incorporation of Revalidation Policies
into Pub. 100-08, Program Integrity
Manual (PIM), Chapter 15 – Rescinded
and replaced by Transmittal 578
05/15/2015 9011
R561PI 	12/12/2014 Incorporation of Certain Provider
Enrollment Policies in CMS-4159-F into
Pub. 100-08, Program Integrity Manual
(PIM), Chapter 15
04/18/2015 8901
R556PI 	11/26/2014 Revisions to Pub. 100-08, Program
Integrity Manual (PIM), Chapter 15
12/29/2014 8810
R539PI 	08/29/2014 Cardiac Rehabilitation Programs for
Chronic Heart Failure – Rescinded and
replaced with Transmittal 539
08/18/2014 8758
R532PI 	08/01/2014 Incorporation of Various Form CMS-855
Processing Activities into Pub. 100-08,
Program Integrity Manual (PIM), Chapter
15
09/02/2014 8842
R530PI 	07/18/2014 Cardiac Rehabilitation Programs for
Chronic Heart Failure – Rescinded and
replaced with Transmittal 539
08/18/2014 8758
R525PI 	06/27/2014 Update to Form CMS-855 Application
Processing Sections of CMS Pub. 100-08,
Chapter 15
07/29/2014 8637
R521PI 	06/13/2014 Submission of Community Mental Health
Center (CMHC) Certifications of
Compliance with Section 485.918(b)(1)
07/15/2014 8784
R519PI 	05/30/2014 Revision to CMS Publication 100-08,
Chapter 15
07/31/2014 8512
R517PI 	05/16/2014 Update to Surety Bond Collection
Procedures
06/17/2014 8636
R514PI 	05/02/2014 Update to CMS Publication 100-08,
Chapter 15
06/03/2014 8682
R509PI 	03/27/2014 Change in Provider Enrollment
Timeliness Standards
06/02/2014 8551
R507PI 	02/28/2014 Change in Provider Enrollment 	05/29/2014 8551

Rev # 	Issue Date 	Subject 	Impl Date CR#
Timeliness Standards – Rescinded and
replaced by Transmittal 509
R503PI 	01/24/2014 Inter-Jurisdictional Reassignments 	02/25/2014 8545
R502PI 	01/17/2014 Registration of Entities Using the Indirect
Payment Procedure (IPP)
01/06/14 	8284
R499PI 	12/27/2013 Update to Chapter 15 of the Program
Integrity Manual
01/28/2014 8544
R494PI 	12/06/2013 Registration of Entities Using the Indirect
Payment Procedure (IPP)
01/06/14 	8284
R492PI 	12/06/2013 Additional Updates to Chapter 15 of the
Program Integrity Manual (PIM)
01/07/2014 8393
R490PI 	11/06/2013 Reassignment to Part A Critical Access
Hospitals Billing Under Method II (CAH
II)
01/06/2014 8387
R483PI 	08/16/2013 Reassignment to Part A Critical Access
Hospitals (CAHs), Federally Qualified
Health Centers (FQHCs), and Rural
Health Clinics (RHCs) – Rescinded and
replaced by Transmittal 490
01/06/2014 8387
R479PI 	08/01/2013 Enrollment Denials When an Existing or
Delinquent Overpayment Exists
10/07/2013 8039
R478PI 	08/02/2013 Registration of Entities Using the Indirect
Payment Procedure (IPP) – Rescinded
and replaced by Transmittal 494
01/06/2014 8284
R474PI 	07/05/2013 Update to Chapter 15 of the Program
Integrity Manual (PIM)
10/08/2013 8341
R471PI 	06/11/2013 Update to Chapter 15 of the Program
Integrity Manual (PIM)
05/28/2013 8222
R470PI 	05/31/2013 Revision to Surety Bond Collection
Process
07/01/2013 8283
R469PI 	05/31/2013 Enrollment Denials When an Existing or
Delinquent Overpayment Exists –
Rescinded and replaced by Transmittal
479
10/07/2013 8039
R463PI 	05/17/2013 Model Letter Revisions 	06/07/2013 8117
R462PI 	05/16/2013 Update to Chapter 15 of the Program
Integrity Manual (PIM)
03/18/2013 8155
R461PI 	04/26/2013 Update to Chapter 15 of the Program
Integrity Manual (PIM) – Rescinded and
05/28/2013 8222

Rev # 	Issue Date 	Subject 	Impl Date CR#
replaced by Transmittal 471
R459PI 	04/12/2013 Tax Identification Numbers of Foreign
Owning and Managing Entities and
Individuals
05/13/2013 8258
R457PI 	04/02/2013 Model Letter Revisions – Rescinded and
replaced by Transmittal 463
04/22/2013 8117
R456PI 	03/22/2013 Model Letter Revisions – Rescinded and
replaced by Transmittal 457
04/22/2013 8117
R450PI 	02/15/2013 Update to Chapter 15 of the Program
Integrity Manual (PIM) – Rescinded and
replaced by Transmittal 462
03/18/2013 8155
R445PI 	12/14/2012 Revision to Section 15.5.20 of Chapter 15
of the Program Integrity Manual (PIM)
01/01/2014 7864
R440PI 	11/23/2012 Revisions to Appeals Section of Chapter
15 of the Program Integrity Manual
(PIM)
12/24/2012 8110
R437PI 	11/02/2012 Revision to Section 15.5.20 of Chapter 15
of the Program Integrity Manual (PIM) –
Rescinded and replaced by Transmittal
445
02/01/2013 7864
R435PI 	10/19/2012 General Update to Chapter 15 of the
Program Integrity Manual (PIM)-Part IX
11/20/2012 8019
R433PI 	09/07/2012 Review of Debarment List and
Processing of Tie-in Notices
10/09/2012 8020
R431PI 	08/31/2012 Ordering and Certifying Documentation-
Maintenance Requirements
10/01/2012 7890
R430PI 	09/28/2012 General Update to Chapter 15 of the
Program Integrity Manual (PIM)-Part
VIII
10/29/2012 7889
R424PI 	06/13/2012 General Update to Chapter 15 of the
Program Integrity Manual (PIM)-Part VI
06/19/2012 7827
R423PI 	06/01/2012 General Update to Chapter 15 of the
Program Integrity Manual (PIM)-Part VII
07/02/2012 7839
R421PI 	05/18/2012 General Update to Chapter 15 of the
Program Integrity Manual (PIM)-Part VI
– Rescinded and replaced by Transmittal
424
06/19/2012 7827
R416PI 	04/13/2012 General Update to Chapter 15 of the
Program Integrity Manual (PIM)-Part III
02/27/2012 7698

Rev # 	Issue Date 	Subject 	Impl Date CR#
R415PI 	04/13/2012 General Update to Chapter 15 of the
Program Integrity Manual (PIM)-Part V
05/14/2012 7797
R414PI 	04/06/2012 General Update to Chapter 15 of the
Program Integrity Manual (PIM)-Part IV
05/07/2012 7763
R412PI 	03/30/2012 General Update to Chapter 15 of the
Program Integrity Manual (PIM)-Part II
04/30/2012 7646
R410PI 	03/02/2012 Instructions for Processing Form CMS-
855O Submissions
06/04/2012 7723
R408PI 	02/22/2012 Additional Provider and Supplier
Enrollment Requirements for Fixed Wing
and Helicopter Air Ambulance Operators
02/03/2012 7363
R407PI 	02/09/2012 Advanced Diagnostic Imaging (ADI)
Accreditation Enrollment
Procedures(This CR Fully Rescinds and
Replaces CR 7177)
01/27/2012 7681
R405PI 	01/26/2012 General Update to Chapter 15 of the
Program Integrity Manual (PIM) –Part III
– Rescinded and replaced by Transmittal
416
02/27/2012 7698
R404PI 	01/20/2012 General Update to Chapter 15 of the
Program Integrity Manual (PIM)-Part I
04/22/2012 7579
R403PI 	01/20/2012 Claims Against Surety Bonds for
Suppliers of Durable Medicare
Equipment, Prosthetics. Orthotics and
Supplies (DMEPOS)
02/21/2012 7167
R402PI 	01/13/2012 Advanced Diagnostic Imaging (ADI)
Accreditation Enrollment
Procedures(This CR Fully Rescinds and
Replaces CR 7177) – Rescinded and
replaced by Transmittal 407
01/27/2012 7681
R400PI 	11/21/2011 Additional Provider and Supplier
Enrollment Requirements for Fixed Wing
and Helicopter Air Ambulance Operators
– Rescinded and replaced by Transmittal
408
02/03/2012 7363
R394PI 	10/27/2011 Additional Provider and Supplier
Enrollment Requirements for Fixed Wing
and Helicopter Air Ambulance Operators
– Rescinded and replaced by Transmittal
400
02/03/2012 7363
R392PI 	10/14/2011 Update to Notifications Sent to State 	11/15/2011 7532

Rev # 	Issue Date 	Subject 	Impl Date CR#
Medicaid Agencies and Child Health
Plans of Medicare Terminations for
Certified Providers and Suppliers and
Medicare Revocations for Providers and
Suppliers. This CR rescinds and fully
replaces CR 7017, 7074 and 7334
R388PI 	09/16/2011 Additional Review Activities for Home
Health Agencies (HHAs)
12/17/2011 7525
R387PI 	09/01/2011 Eligible Physicians and Practitioners
Who Need to Enroll in the Medicare
Program for the Sole Purpose of Ordering
and Referring Services for Medicare
Beneficiaries
10/18/2010 7097
R380PI 	08/03/2011 Advanced Diagnostic Imaging
Accreditation Enrollment Procedures
07/05/2011 7177
R374PI 	05/06/2011 Update to Notifications Sent to State
Medicaid Agencies and Child Health
Plans of Medicare Terminations for
Certified Providers and Suppliers and
Medicare Revocations for Providers and
Suppliers
06/06/2011 7334
R373PI 	04/07/2011 Advanced Diagnostic Imaging
Accreditation Enrollment Procedures –
Rescinded and replaced by Transmittal
380
07/05/2011 7177
R372PI 	03/25/2011 Effective Date of Certified Provider or
Supplier Agreement or Approval
04/25/2011 7232
R371PI 	03/23/2011 Implementation of Provider Enrollment
Provisions in CMS-6028-FC
03/25/2011 7350
R369PI 	03/11/2011 Advanced Diagnostic Imaging
Accreditation Enrollment Procedures –
Rescinded and replaced by Transmittal
373
06/12/2011 7177
R365PI 	01/28/2011 Diabetes Self-Management Training
(DSMT)
04/29/2011 7236
R363PI 	01/14/2011 Clarification for Part A Contractors
Including Audit and Claims
Intermediaries Notifying Each Other via
E-mail Upon Processing of the Initial
Enrollment Application, Change of
Information, Voluntary Termination, or
02/15/2011 7221

Rev # 	Issue Date 	Subject 	Impl Date CR#
Any Other CMS-855 Transaction
R358PI 	10/29/2010 Indian Health Service (IHS) Facilities and
Tribal Provider’s Use of Internet-based
Provider Enrollment, Chain and
Ownership System (PECOS)
11/29/2010 7174
R357PI 	10/01/2010 Durable Medical Equipment (DME
MAC) and the National Supplier
Clearinghouse (NSC MAC) Procedures
for Third Party Notification of Deceased
Durable Medical Equipment, Prosthetic,
Orthotic and Supplies (DMEPOS)
Supplier Associates
10/04/2010 6714
R356PI 	09/24/2010 Manual Redesign 	10/26/2010 7083
R355PI 	09/17/2010 Eligible Physicians and Practitioners
Who Need to Enroll in the Medicare
Program for the Sole Purpose of Ordering
and Referring Services for Medicare
Beneficiaries
10/18/2010 7097
R354PI 	08/27/2010 Manual Redesign 	09/28/2010 7016
R353PI 	08/27/2010 Notification to State Medicaid Agencies
and Child Health Plans of Medicare
Terminations for Certified Providers and
Suppliers
09/28/2010 7074
R350PI 	08/20/2010 Notification to State Medicaid Agencies
and Child Health plans of Medicare
Revocation
09/21/2010 7017
R347PI 	07/15/2010 Chapter 10 Manual Redesign - Initial
release of Chapter 15
07/30/2010 6938
R346PI 	06/25/2010 Guidance on Implementing Section 3109
of the Patient Protection and Affordable
Care Act (PPACA)
01/03/2011 7021
R344PI 	06/18/2010 Chapter 10 Manual Redesign - Initial
release of Chapter 15 - Rescinded and
replaced by Transmittal 347
07/05/2011 6938
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