Reactivations
Correspondence Address Change
855R Termination
Special Payment Address Change
General Maintenance
100
This application is used to reactivate a group member file.
What is the CMS-855R.
100
The effective date for the Correspondence Address change.
What is the provider/AO/DO signature date.
100
Check this screen to determine if any claims have paid after the requested date of termination.
What is the MCS FA screen.
100
You can verify the change with this person if the individual provider or the AO/DO cannot be reached.
What is the Contact Person.
100
Take this action prior to working a Maintenance application (Preliminary Checkout).
What is check the Revalidation listing.
200
This application is used to reactivate a Physician Assistant.
What is the CMS-855I.
200
After approval, this is where you copy the DCN to in Highview.
What is the PTAN(s).
200
This person must sign when the group is initiating the termination.
Who is the Authorized or Delegated Official of the group.
200
You must check the MCS CO screen to determine why this Action Reason code was added to the provider file.
What is AR 60.
200
This is used as the effective date for the change when a change of information is reported for a section that does not include a date field (e.g., Section 2).
What is the signature date.
300
When the provider’s enrollment record is in this status, create the 855I L&T to reactivate the reassignment. There is no need to also create an 855R L&T in this situation.
What is Deactivated status.
300
Take this action to verify the change of Correspondence Address.
What is call the individual provider or the AO/DO for groups.
300
This is the L&T submittal reason for the 855R termination.
What is Termination of a Current Reassignment.
300
This form is required if the AR 60 was added due to a returned payment.
What is CMS-588.
300
Any change in the provider's phone number or address that is not caused by the provider (i.e., area code change, municipality renames the provider's street) must still be updated via this form.
What is a CMS-855.
400
This is the Medicare effective date assigned for Reactivations.
What is the originally issued Medicare effective date.
400
This is the Edit Reason in PECOS when end dating the old Correspondence Address.
What is 'Historic Address.'
400
This is the reassignment end date entered into PECOS.
What is the termination date plus one day.
400
This is the date of change for the Special Payment Address.
What is the change date provided on the application.
400
If an individual has an approved Ordering and Referring enrollment record in PECOS (855O) and tries to submit an 855I to become a billing provider, PECOS will detect the approved record and make the provider take this action on the 855O record before the new application can be processed.
What is Withdraw the 855O record.
500
After navigating to the Historical reassignments in Section 4, this is selected to reactivate a reassignment in PECOS Section 4.
What is the "Reactivate" hyperlink in the Action column.
500
Enter the changes that were made on this screen in MCS.
What is the MCS CO screen for ALL PTANs on the provider file.
500
Take this additional action if terminating/deactivating the only PTAN on file for the individual.
What is Create an 855I L&T for Voluntary Termination and close a Deactivated.
500
Take this action on the V2 screen after updating a Special Payment Address when an AR 60 is on file.
What is end date the AR 60.
500
Take this action to determine what changes were submitted on the application.
What is compare the application received to the PSUP/PECOS file.
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