decisionhealth Newsletters, Answer Books - 2006 Issue 10 (October)
Medicare_Program_Integrity_Manual / Chapter_10 / 3.2
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Article Overview
This article covers Medicare enrollment application handling rules from the Program Integrity Manual, focusing on when a contractor must return an application, what happens after a return, and related documentation and system-processing steps. It is relevant to enrollment staff, Medicare contractors, and compliance or provider enrollment professionals who need to understand application intake and rejection-versus-return distinctions. The guidance also references specific CMS enrollment forms and the timing and submission conditions associated with them.
Why This Topic Matters
Accurate handling of enrollment applications affects whether Medicare enrollment processing can continue, whether records are created in PECOS, and how providers are instructed to resubmit documentation. Understanding this section helps avoid processing errors and supports consistent contractor workflow.
Article Sections
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Returning the Application
Explains the circumstances under which a Medicare enrollment application is returned instead of processed further. It also outlines the contractor’s required follow-up actions after a return.
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Note: rejected vs. returned application
Clarifies the distinction between a rejected application and a returned application in the context of provider enrollment processing.
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If the contractor returns the application
Describes the general steps a contractor must take after returning an application, including notification, record handling, and resubmission considerations.
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Note: CMS-855A and CMS-855B authority issue
Addresses a special processing note for certain enrollment forms when a signature appears valid but authority to sign is in question.
What You Will Learn
- The general situations that trigger return of a Medicare enrollment application
- How returned applications are handled by contractors
- The distinction between a returned application and a rejected application
- How related enrollment documents and resubmissions are treated
- Special processing notes tied to certain CMS enrollment forms
Who Should Read This
- Medicare enrollment contractors
- Provider enrollment staff
- Compliance professionals
- Revenue cycle and billing staff
- Healthcare administrative personnel
Codes Discussed
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