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Provider Enrollment: Top Reasons Behind Delays in Processing the Application

Medicare enrollment plays a vital role in ensuring compliance with CMS requirements. To help streamline the process and achieve the best results, it's important to submit all necessary information and documentation with your enrollment application, whether electronically in PECOS or on the paper CMS-855. By focusing on the details of your application type and verifying information carefully, you can enjoy a quicker and more efficient processing experience.

Below are common reasons for development:

Reason Resolution
Missing AO/DO information Verify complete and accurate information is provided in the individual control topic in PECOS or in section 6 on the CMS-855 paper application. Missing information may include percent of ownership, SSN/DOB, relationship to the applicant.
Incomplete Signature and Date Verify the Authorized and/or Delegated Officials signs and dates the application, including any newly added AO/DO.
Application Fee Determine if an application fee is required by using the Application Fee Decision Tree Tool
Attachment 1 SNF information and/or missing Organizational Charts SNF specialty must complete attachment 1

A SNF must submit the below identifying charts:

  1. A chart identifying all the entities listed in Section A of the Organizations section of the Attachment that shows their relationships with the SNF and each other. (This chart will thus include the SNF’s organizational ADPs.)
  2. A chart identifying the organizational structures of all its owners, including owners not listed in the SNF Attachment (e.g., less than 5% direct or indirect owners of corporations). This includes entities AND individuals that are owners.
  3. A chart outlining the organizational structures of each ADP of the facility. This must include a written description of the relationship of each ADP to the facility and to all the SNF’s other ADPs. However, only organizational and individual owners that fall within the “organizational structure” definition need be reported on this chart.
Missing required supporting documents Depending on the enrollment specialty and type of application submitted examples are:
  • Operational License
  • Certifications
  • CMS-588
  • Exhibit 177 for an FQHC
  • Stock transfer/sales agreement
  • Capitalization for HHA initial enrollment

Review the article Supporting Documentation Information for assistance
Missing medical directors and/or administrators for a Hospice or SNF

PECOS identify under the individual control topic.

CMS-855A paper application

  • Hospice identify under section 6
  • SNF identify under attachment 1

Resources on our website to assist with application submission:

Posted 3/17/2025

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