You've Got 30 Days

 What You Need to Know

To maintain your Medicare billing privileges you must report any changes to your Medicare enrollment information in a timely fashion. Supplier Standard 2 requires that you must notify National Provider Enrollment within 30 days of any change to your information as listed on the CMS-855S enrollment form or as recorded in PECOS.

Common changes you must report include:

• Adding or discontinuing a specialty, product, or service
• Changing your business location
• Updating your ownership or control information
• Modifying your legal business name
• Voluntarily terminating your Medicare enrollment

Any change request should include the following sections of the CMS-855S:

• Section 1A & 1B – Indicate the reason for the submission and specify what is changing;
• Section 2B – Update business identifiers (LBN, NPI, TIN, PTAN);
• Section 3 – Review and disclose any final adverse legal actions;
• Section 13 – Provide a contact person for follow-up; and
• Section 15B or 15D – Include required signatures; stamped signatures are not accepted.

Below is a list of common enrollment info changes and their applicable sections in the 855S:

• Address changes: Update Section 2A1 (location and contact info) and the appropriate 4-series mailing address fields (4A–4E);
• Ownership changes: Complete Sections 5 (organizational) or 6 (individual), along with Section 3;
• Products and services: Update Section 2E;
• Voluntary termination: Indicate effective date in Section 1A and update addresses in Section 4 if applicable; and
• Legal business name changes: Include Sections 2B and 4A, along with an IRS document verifying the name change

Finally, when adding a new product or service, you must also ensure compliance with Supplier Standard 1, which requires submission of applicable state licenses. While CMS provides a Licensure Database as a reference, it's ultimately your responsibility to verify and obtain all necessary state and federal licensure.

What This Means for You

Timely and accurate reporting to your National Provider Enrollment contractor helps ensure uninterrupted billing privileges and compliance with Medicare requirements. Review your enrollment information regularly and keep documentation on file to support any updates submitted. Failure to report these changes on time can result in revocation of your billing privileges and potential overpayments.

Novitas is the NPE contractor for the East Region. Noridian is the NPE contractor for the West Region.