Revised April 22, 2008
Avoid Provider Enrollment Delays - Check Your Application Before Mailing
Did you know incomplete enrollment applications may result in significant delays?
First Coast Service Options, Inc. (FCSO) pre-screens enrollment applications to verify they include required data elements and supporting documentation. Applications will be returned without further review if certain conditions exist. The most common reasons for returned applications include:
1. An outdated version of the CMS-855 application(s) was submitted.
Effective April 4, 2008, CMS issued new application forms for providers enrolling with Medicare. With the exception of specialty hospitals who are required to use the revised application immediately, all other providers and suppliers are encouraged to use the revised version. The 04/06 and 06/06 version of the applications will continue to be accepted through June 30, 2008.
2. The CMS-855 and/or CMS-588 application was not signed and/or dated.
The appropriate individual(s) must sign and date the application in ink. Signatures must not be copied or stamped.
3. The reassignment package submitted was incomplete.
• CMS 855-R was submitted alone – If a new group with new practitioners submits only the CMS-855R forms for its group members, and does not include all required applications (CMS-855B and/or CMS-855I) necessary to process the enrollment package, the CMS-855R forms will be returned.
• CMS-855B was submitted alone – If a new group wants to enroll and submits only the CMS-855B, without attaching the CMS-855I forms and CMS-855R forms for the group members not currently enrolled, the applications will be returned. Forms CMS-855I and/or CMS-855R are necessary to process the enrollment package for the group.
4. The CMS-855R application was signed by an unauthorized official whose signature is not on file with Medicare.
FCSO processes applications in the order they are received. Providers must correct and resubmit applications that are returned by FCSO. Resubmitted applications are considered a new receipt and will be processed in the order of receipt. The most common items missing from applications include:
• Medical or professional licenses, certifications, and registrations required by Federal or State law.
• National Provider Identifier (NPI).
• Internal Revenue Service (IRS) CP-575 documentation.
• Interim sales agreements.
If an application is missing at least one required data element or supporting document, FCSO will send you a letter (referred to as a pre-screening letter), via fax, requesting the information needed to continue processing your application. When a fax number is not available, FCSO will mail this letter to the correspondence address noted in the application.
Providers have 60 days from the date of the pre-screening letter to return all requested information. If all requested information is not returned in 60 days, FCSO will reject the application. Once rejected, the provider must resubmit the application, which will be processed in the order of receipt.
Where to go for help
Enrollment applications, tips to facilitate the enrollment process and answers to commonly asked questions can be found on the Medicare Provider-Supplier Enrollment 
page of the CMS Web site. Specific instructions for completing the enrollment applications are outlined within each section of the application.
page of the CMS Web site. Specific instructions for completing the enrollment applications are outlined within each section of the application. The official Medicare contractor instructions pertaining to provider enrollment are in the Medicare Program Integrity Manual 
, also on the CMS site.
, also on the CMS site. FCSO provides Tips to Expedite your Medicare Enrollment Process on our Web site.
You may also find it helpful to contact your Medical Association or Society.
If you are experiencing difficulty accessing the appropriate forms or have general questions regarding the enrollment process, please contact our Provider Customer Service Department at 1-866-454-9007.
