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| DME Home |  | ► | | Articles | | ► | | Products/services and states/territories reported on the CMS-855S application | |
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When submitting a CMS-855S application to enroll, or update these elements in your enrollment record: Select only the State(s)/Territory(ies) where you are currently licensed to provide items or services to Medicare beneficiaries from the business location provided on the CMS-855S application. For each State/Territory selected, submit all required licenses and/or certifications for the products and services being provided. Select only the products and services that you are currently licensed/certified to furnish and submit copies of those licenses and/or certifications. If you fill orders, fabricate, or fit items by contracting with other companies for the purchase of items necessary to fill the order, submit copies of all applicable contracts. Ensure the accreditation information for the selected products/services is included on the application. Do not select a State(s)/Territory(ies) or product/service where you are pending licensure because we are unable to add this information to your enrollment record. We will call for clarification in situations where there are more States/Territories, or products/services reported than we typically encounter. If extraneous information is provided, we will develop for an updated CMS-855S. Providing excess/unnecessary information complicates our verification process and slows processing timelines. Also, failure to attach applicable licensure, certification and/or contracts could result in denial or revocation of your Medicare billing privileges.
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