Make Changes - JF Part B
Make Changes to Provider Information
Submitting applications via Internet-based Provider Enrollment, Chain and Ownership System (PECOS) Web is the preferred method. It has advantages that include:
- Faster application process
- Automatic selection of proper enrollment form(s)
- Fewer submission errors/omissions
View more information about PECOS Web, view the PECOS Web - Enroll and Make Changes Online webpage.
Noridian encourages providers/suppliers to make updates online using Internet-Based PECOS Web.
Physicians, non-physicians and organizations (groups) must report the following changes within 30 days of the change taking effect.
A change of ownership
- All individuals and organizations reported in Sections 5 and 6 of CMS-855B, including Authorized Officials (AO) and Delegated Officials (DO)
A final adverse legal action
- A change in "final adverse action" should include any suspensions, revocations or orders to relinquish a license no matter the duration of action
A change in practice location
- A change in practice location occurs when a physician retires, voluntarily withdraws from Medicare, changes their practice location or adds a practice location
All other changes must be reported within 90 days
Independent Diagnostic Testing Facilities (IDTFs)
Report the following changes within 30 days of the change taking effect.
- A change in ownership
- A change of location
- A change in general supervision
- A final adverse legal action
All other changes must be reported within 90 days.
If a change in ownership, final adverse action or change in practice location is not reported within the 30 days, contractors may need to revoke the provider's Medicare record. A revocation period can last from one to three years. The provider/supplier will be unable to bill Medicare services during this timeframe.
Report changes of information on appropriate CMS-855 form. Notifying Noridian of any changes on a business letterhead is not acceptable
- Individuals report changes on CMS-855I Form
- Sole Owners report changes on CMS-855I Form
- Organizations report changes on CMS-855B Form
- Respond to Medicare's Requests for Information (RFI) as soon as possible. Failure to respond to these requests will result in application being rejected and possible deactivation. Ensure contact information is correct and up to date
- All applications require original signatures that are dated within 120 days of Medicare receiving the application. For organization change applications, only company Authorized Official (AO) can sign certification statement in Section 15. If Delegated Official (DO) is submitting change application, they should sign Section 16
- If changing legal business name, ensure IRS document, NPPES and new legal name all match
Last Updated Tue, 17 Oct 2017 10:35:23 +0000