Get Help Completing My Enrollment Application

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 explaining 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

Table of Contents

• Avoiding Common Errors
• Information and Instructions on Section 5 and 6 of the CMS 855A Application
  • Section 5 – Ownership interest and/or managing control information (organizations)
• Instructions on Completing Section 5
  • Section 5A - Ownership/Managing Control Organization
  • Section 5B - Ownership/managing control Information
  • Section 5C - Chain Home Offices Only
  • Section 5D - Final Adverse Legal Action History
  • Section 6 – Ownership interest and/or managing control information (individuals)
• Instructions on Completing Section 6
  • Section 6A - Ownership/Managing Control Organization
  • Section 6B - Final Adverse Legal Action History
• Related Content

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Avoiding Common Errors

There are some common errors made during the enrollment process. Avoid making these mistakes to 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 not listing the legal business name as it is registered with the IRS.
• Section 2 is missing license and/or certification information or it has expired.
• Change/Add/Remove not checked and/or missing effective date.
• Section 6 an individual not holding the appropriate role to be added as an authorized official and/or not adding a new authorized/delegated official.
• Section 6 for Hospice enrollments not adding or updating Medical Director or Administrator.
• 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 confirmation letter on bank letterhead listing the IRS legal business name as the account name and associated routing number and account number.
• CMS-588 form is signed by someone other than an authorized or delegated official.
• Provider chooses to print certification statement(s) for PECOS submission however they forget to upload (PDF or TIFF) signed and dated document.
• Supporting documentation is not uploaded (PDF or TIFF) in PECOS or mailed to the MAC.

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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.

• Check the box if you are a Skilled Nursing Facility (SNF) and skip this section. All organizational ownership interest and managing control infomration must be reported in Attachment 1. SNF must submit 2 organizational structure diagrams or flowcharts:
  • One chart must identify all the entities listed in Attachment 1, Section A and show their relationships with the provider and each other.
  • One chart must identify the organizational structures of all its owners, including owners not listed in this attachment (e.g., less than 5% direct or indirect owners).

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
• Private equity company
• Real estate investment trusts

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

• An organizational diagram identifying all the entities listed in this section and their relationships with the provider and with each other.

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.

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Instructions on Completing Section 5

Section 5A - Ownership/Managing Control Organization

Check the box if you are a Skilled Nursing Facility (SNF) and skip this section. All organizational ownership interest and managing control information must be reported in Attachment 1.

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 5D; complete section 5C, if applicable.

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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.

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Section 5C - Chain Home Offices Only

When applicable, identify the chain home office information.

• Report the individual chain home office administrator

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Section 5D - 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.

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

Check the box if you are a Skilled Nursing Facility (SNF) and skip this section. All individual ownership interest and managing control information must be reported in Attachment 1. The diagrams or flowcharts referred to in the organization instructions must include all 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

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Instructions on Completing Section 6

Section 6A - Ownership/Managing Control Organization

Check the box if you are a Skilled Nursing Facility (SNF) and skip this section. All individual ownership interest and managing control information must be reported in Attachment 1.

Complete with the identifying information 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.

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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.

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Related Content

• CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 10
• Medicare Provider-Supplier Enrollment web page
• MLN Educational Tool^®: Medicare Provider Enrollment
• Tips to Facilitate the Medicare Enrollment Process
• “Who Should I Call?” CMS Provider Enrollment Assistance Guide

Revised 10/22/2024