Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you can find this information:

• PECOS website – PECOS is the fastest way to complete the enrollment process. This site has enrollment tutorials that are very helpful in explain the process of enrollment and step-by-step instructions that you can follow as you complete your Medicare enrollment
• CMS website – This site features manuals and downloads to help you better understand the process of enrollment and the guidelines you have to follow to submit a successful application

Provider Enrollment Customer Care

You always have the option of contacting the National Government Services Provider Enrollment Customer Care toll-free!

Avoiding Common Errors

There are some common errors made during the enrollment process. Avoiding making these mistakes can ensure your application is processed without being returned for revision. Some of the common errors include:

• No fee is submitted when it is required
  • Need Help? Refer to the Pay an Application Fee section to help determine whether you need to submit an application fee.

• Not all required sections of the application are submitted or required sections are only partially completed
• Supporting documentation is missing. If you are filing a paper application, you can find a list of supporting documents in section 17. If filing a PECOS web application, PECOS will display a list of the supporting documentation needed.
• Section 2 is completed using the Doing Business As name instead of the Legal Business Name reported to the IRS
• Section 2 is missing license and/or certification information or it has expired
• Change/Add/Delete not checked off and effective date missing in sections 4, 5, 6, 7, 8, 15, 16
• Section 6 not filled out when trying to add a new authorized/delegated official
• Revalidations: PECOS has practice locations, organizations or individuals listed in sections 4, 5, 6, respectively, that are not reported or deleted on the CMS-855A
• CMS-588 form is submitted without a copy of a voided check or signed bank letter on bank letterhead listing the account name/routing number/account number
• CMS-588 form is signed by someone other than an Authorized or Delegated Official
• Provider chooses to print and sign certification statement(s) however they forget to mail to the MAC
• Supporting documentation is not uploaded (PDF or TIFF) in PECOS or mailed to the MAC

Information and Instructions on Section 5 and 6 of the CMS 855A Application

SECTION 5 –Ownership interest and/or managing control information (organizations)

This section is to be completed with information about any organization that has direct or indirect ownership of, a partnership interest in, and/or managing control of the provider identified in section 2 (applicant). If there is more than one organization, copy and complete the entire section for each. The provider entity itself should not be listed in Section 5.

All entities that must be listed included but not limited to any organizations that have:

• 5% or greater direct or indirect ownership
• Mortgage or security interest (banks or financial institutions)
• Partnerships (general or limited)
• Investment interest (investment firms)
• Holding companies
• Trusts or trustees
• Governmental/tribal organizations
• Charitable and religious organizations
• Managing control organizations
• Chain home offices (all chain home offices reported in Section 7 of the 855A must also be reported in Section 5)

NOTE:  If the provider is a physician–owned hospital as identified in section 2A, Question 4, then the provider must complete the CMS 855 POH Annual Report and include every organization that has any percentage of ownership or investment interest in the provider.

In additional to furnishing the information in this section, the provider must submit: 

• An organizational diagram identifying all of the entities listed in this section and their relationships with the provider and with each other.
• A diagram identifying the organizational structures of all of its owners, including owners that were not required to be listed in this section or in Section 6, only if the provider is a skilled nursing facility.

Note that the diagrams must include all individuals with any of the ownership interests indicated in Section 6.

Using the information above Company A (100%), B (40%) and C (60%) is at least 5% or greater direct or indirect ownership they must be indicated in section 5.  Individual Y (12%) is at least 5% or greater indirect ownership they must be indicated in section 6. Since Individual X (3%) is less than 5% indirect owner, they do not need to be listed in section 6 but must be indicated in diagram. 

Instructions on Completing Section 5

Section 5A - Ownership/Managing Control Organization

Complete with the identifying information of each organization and indicate the type of organization. Each organization listed in section 5A must have a section 5B AND section 5C.

Section 5B - Ownership/managing control Information

Identify the type of ownership and/or managing control of each organization identified in section 5A. Check all that apply (up to 8 options to select).

Section 5C - Final Adverse Legal Action History

Report any final adverse legal action imposed against each organization identified in section 5A. Question 1 must be answered by selecting Yes or No. If yes, submit a copy of the adverse legal action documentations and resolutions. 

SECTION 6 – Ownership interest and/or managing control information (individuals)

This section is to be completed with information about any individual that has direct or indirect ownership of, a partnership interest in, and/or managing control of the provider identified in section 2 (applicant). If there is more than one individual, copy and complete the entire section for each. Note that the applicant must have at least one managing employee.

All individuals that must be listed include but not limited to any individual that have:

• 5% or greater direct or indirect ownership interest
• 5% or greater mortgage or security interest
• General or limited partnership interest
• Trustees or Board of Directors
• Officers and directors
• W-2 managing employee
• Contracted managing employee
• Operational/managerial control
• Chain home office administrator – any chain home office administrator reported in Section 7 of the 855A must also be reported in Section 6.

NOTE:  If the provider is a physician–owned hospital as identified in section 2A, Question 4, then the provider must complete the CMS 855 POH Annual Report and indicate every individual that has any percentage of ownership or investment interest in the provider.

Instructions on Completing Section 6

Section 6A - Ownership/Managing Control Organization

Complete with the identifying information of each individual and indicate the type of ownership and/or managing control of each individual. Check all that apply (up to 12 options to select). Each individual listed in Section 6A must have a Section 6B.

Section 6B - Final Adverse Legal Action History

Report any final adverse legal action imposed against each individual identified in section 6A. Question 1 must be answered by selecting Yes or No. If yes, submit a copy of the adverse legal action documentations and resolutions.

Related Content

• CMS IOM Publication 100-08, Medicare Program Integrity Manual
• Medicare Provider-Supplier Enrollment
• The Basics of Medicare Enrollment for Institutional Providers
• “Who Should I Call?” CMS Provider Enrollment Assistance Guide
• Medicare Provider-Supplier Enrollment web page
• Tips to Facilitate the Medicare Enrollment Process