Medicare Program Integrity Manual 
Chapter 15 - Reserved for Future Use
  
 
Table of Contents 
(Rev. 10945, 08-12-21) 
 
 
Transmittals for Chapter 15 
 
    Transmittals Issued for this Chapter 
 
Rev #  Issue Date  Subject  Impl Date  CR# 
R10945PI 08/12/2021  Removal of Provider Enrollment Policy  09/13/2021 12391 
from Chapter 15 in Publication (Pub.) 
100-08 
R10723PI 04/08/2021  Implementation of Provider Enrollment  08/10/2020 11551 
Provisions in CMS-6058-FC  Phase 1  
Continued Removal/Moving of 
Instructions from Chapter 15 of 
Publication (Pub.) 100-08 to Chapter 10 
of Pub. 100-08 
R10611PI 03/19/2021  Completion of Removal/Moving of  11/19/2020 11917 
Instructions from Chapter 15 of 
Publication (Pub.) 100-08 to Chapter 10 
of Pub. 100-08 
R10524PI 12/17/2020  Chapter 15 of Publication (Pub.) 100-08  11/13/2020 11700 
Manual Redesign  Additional Release of 
Chapter 10 
R10383PI 10/09/2020  Updates to Chapters 4, 5, 8, 15, and  11/10/2020 11999 
Exhibits of Publication (Pub.) 100-08 
 
R10355PI 09/18/2020  Completion of Removal/Moving of  11/19/2020 11917 
Instructions from Chapter 15 of 
Publication (Pub.) 100-08 to Chapter 10 
of Pub. 100-08- Rescinded and replaced 
by transmittal 10611 
R10353PI 09/11/2020  Chapter 15 of Publication (Pub.) 100-08  02/01/2021 11865 
Manual Redesign  Additional Release of 
Chapter 10 of Pub. 100-08, Modification 
of the Timeliness Standards 
R10345PI 09/11/2020  Chapter 15 of Publication (Pub.) 100-08  11/13/2020 11700 
Manual Redesign  Additional Release of 
Chapter 10- Rescinded and replaced by 
transmittal 10524 
 
R10239PI 07/28/2020  Implementation of Provider Enrollment  08/10/2020 11551 
Provisions in CMS-6058-FC  Phase 1  
Continued Removal/Moving of 
Instructions from Chapter 15 of 
Publication (Pub.) 100-08 to Chapter 10 
of Pub. 100-08- Rescinded and replaced 
by Transmittal 10723  Rev #  Issue Date  Subject  Impl Date  CR# 
R10182PI 06/15/2020  Update to Chapter 10 of Publication  09/16/2020 11375 
(Pub.) 100-08 - Model Letter Templates 
R10146PI 05/22/2020  Implementation of Provider Enrollment  07/24/2020 11551 
Provisions in CMS-6058-FC  Phase 1  
Continued Removal/Moving of 
Instructions from Chapter 15 of 
Publication (Pub.) 100-08 to Chapter 10 
of Pub. 100-08- Rescinded and replaced 
by Transmittal 10239 
R10138PI 05/15/2020  Moving Chapter 15 (Medicare  06/16/2020 11546 
Enrollment) Manual Instructions in 
Publication (Pub.) 100-08 to Chapter 10 
(Medicare Enrollment) 
  11/22/2019  Additional Guidance on Private  12/24/2019 10939 
Contracting/Opting-out of Medicare and 
Entering Opt-out Affidavit Records in the 
Provider Enrollment, Chain and 
Ownership System (PECOS) 
R904PI  09/27/2019  Provider Enrollment Rebuttal Process  12/31/2019 10978 
R902PI  09/27/2019  Updates to Chapters 3, 4, 8, 15, and  10/28/2019 11425 
Exhibits of Publication (Pub.) 100-08 
R898PI  09/06/2019  Updates to Provider Enrollment  10/07/2019 11371 
Processing Instructions in Chapter 15 of 
Publication (Pub.) 100-08, Program 
Integrity Manual, and to the CMS-855R 
Processing Guide 
 
R896PI  08/30/2019  Updates to Provider Enrollment  10/01/2019 11325 
Processing Instructions in Chapter 15 of 
Publication (Pub.) 100-08 
R882PI  05/24/2019  Additional Processing Procedure for  06/25/2019 11246 
Adding a New Provider-Based Location 
for Critical Access Hospitals (CAHs) 
 
R865PI  02/21/2019  Update to Chapter 15 of Publication  03/12/2019 10954 
(Pub.) 100-08 
 
R862PI  02/08/2019  Update to Chapter 15 of Publication  03/12/2019 10954 
(Pub.) 100-08- Rescinded and replaced  Rev #  Issue Date  Subject  Impl Date  CR# 
by Transmittal 865 
 
R824PI  09/052018  Update to Chapter 15 of Publication  10/01/2018 10845 
(Pub.) 100-08, Certification Statement 
Policies 
R822PI  08/24/2018  Update to Chapter 15 of Publication  10/01/2018 10845 
(Pub.) 100-08, Certification Statement 
Policies- Rescinded and replaced by 
Transmittal 824 
R797PI  06/01/2018  Reviewing for Adverse Legal Actions  04/30/2018 10558 
(ALA) 
R762PI  04/30/2017  Update to Chapter 15 of Pub. 100-08  01/29/2018 10386 
R782PI  03/30/2018  Update to Chapter 15 of Publication 100- 04/30/2018 10443 
08 - Medicare Enrollment Deactivation 
Policies 
R784PI  03/30/2018  Reviewing for Adverse Legal Actions  04/30/2018 10558 
(ALA) 
R773PI  02/23/2018  Form CMS-855O Processing Guide  03/23/2018 10355 
R765PI  01/08/2018  Medicare Diabetes Prevention Program  01/19/2018 10356 
(MDPP) Enrollment Process 
R734PI  07/28/2017  Update to Reporting Requirements  06/27/2017 9924 
R719PI  05/26/2017  Update to Reporting Requirements  06/27/2017 9924 
R718PI  05/19/2017  Reviewing for Adverse Legal Actions  06/20/2017 9879 
(ALA) 
R717PI  05/12/2017  Update to Pub. 100-08, Chapter 15  05/15/2017 9953 
R715PI  05/11/2017  Update to Pub. 100-08, Chapter 15  06/13/2017 9953 
R711PI  04/25/2017  Update to Pub. 100-08, Chapter 15  05/15/2017 9953 
R710PI  04/14/2017  Update to Pub. 100-08, Chapter 15  05/15/2017 9953 
R689PI  12/09/2016  Clarification of Certification Statement  01/09/2017 9776 
Signature and Contact Person 
Requirements 
R688PI  11/18/2016  Update to Pub. 100-08, Chapter 15  07/26/2016 9635 
R685PI  11/03/2016  Incorporation of Cycle 2 Revalidation  09/06/2016 9628 
Policies 
R684PI  11/01/2016  Incorporation of Cycle 2 Revalidation  12/02/2016 9628 
Policies  Rescinded and replaced by 
Transmittal 685 
R681PI  10/27/2016  Revision to Surety Bond Collection  01/30/2017 9755  Rev #  Issue Date  Subject  Impl Date  CR# 
Procedures 
R676PI  09/16/2016  Clarification of Certain Policies in Pub.  12/19/2016 9552 
100-08, Chapter 15 Regarding the 
Processing of Form CMS-855R 
Applications 
R666PI  08/05/2016  Incorporation of Cycle 2 Revalidation  09/06/2016 9628 
Policies - Rescinded and replaced by 
Transmittal 684 
R659PI  06/24/2016  Update to Pub. 100-08, Chapter 15 -  07/26/2016 9635 
Rescinded and replaced by Transmittal 
688 
R636PI  02/04/2016  Update to Pub. 100-08, Chapter 15  03/04/2016 9390 
R626PI  11/13/2015  Update to Surety Bond Collection  12/14/2015 9296 
Requirements 
R609PI  08/14/2015  Clarification Regarding the Processing of  11/02/2015 9174 
Certain Provider Enrollment-Related 
Transactions 
R605PI  07/31/2015  Clarification Regarding the Processing of  11/02/2015 9174 
Certain Provider Enrollment-Related 
Transactions  Rescinded and replaced by 
Transmittal 609 
R592PI  05/08/2015  Update of Provider Enrollment  06/08/2015 9139 
Instructions in Chapter 15 of Pub. 100-08 
R591PI  05/08/2015  Revisions to Surety Bond Collection  06/08/2015 9123 
Policies 
R590PI  04/24/2015  Update of CMS-855A, Physician-Owned  05/25/2015 9120 
Hospital Reporting Via the CMS-
855POH and Indirect Payment Procedure 
Registration Via the CMS-855C in 
Chapter 15 of Pub. 100-08 
R587PI  04/17/2015  Clarification of Ordering and Certifying  07/20/2015 9112 
Documentation Maintenance 
Requirements 
R582PI  03/04/2015  Incorporation of Certain Provider  05/28/2015 9065 
Enrollment Policies in CMS-6045-F into 
Pub. 100-08, Program Integrity Manual 
(PIM), Chapter 15 
R581PI  02/27/2015  Incorporation of Certain Provider  05/28/2015 9065 
Enrollment Policies in CMS-6045-F into 
Pub. 100-08, Program Integrity Manual  Rev #  Issue Date  Subject  Impl Date  CR# 
(PIM), Chapter 15  Rescinded and 
replaced by Transmittal 582 
R578PI  02/25/2015  Incorporation of Revalidation Policies  05/15/2015 9011 
into Pub. 100-08, Program Integrity 
Manual (PIM), Chapter 15 
R575PI  02/13/2015  Incorporation of Revalidation Policies  05/15/2015 9011 
into Pub. 100-08, Program Integrity 
Manual (PIM), Chapter 15  Rescinded 
and replaced by Transmittal 578 
R561PI  12/12/2014  Incorporation of Certain Provider  04/18/2015 8901 
Enrollment Policies in CMS-4159-F into 
Pub. 100-08, Program Integrity Manual 
(PIM), Chapter 15 
R556PI  11/26/2014  Revisions to Pub. 100-08, Program  12/29/2014 8810 
Integrity Manual (PIM), Chapter 15 
R539PI  08/29/2014  Cardiac Rehabilitation Programs for  08/18/2014 8758 
Chronic Heart Failure  Rescinded and 
replaced with Transmittal 539 
R532PI  08/01/2014  Incorporation of Various Form CMS-855  09/02/2014 8842 
Processing Activities into Pub. 100-08, 
Program Integrity Manual (PIM), Chapter 
15 
R530PI  07/18/2014  Cardiac Rehabilitation Programs for  08/18/2014 8758 
Chronic Heart Failure  Rescinded and 
replaced with Transmittal 539 
R525PI  06/27/2014  Update to Form CMS-855 Application  07/29/2014 8637 
Processing Sections of CMS Pub. 100-08, 
Chapter 15 
R521PI  06/13/2014  Submission of Community Mental Health 07/15/2014 8784 
Center (CMHC) Certifications of 
Compliance with Section 485.918(b)(1) 
R519PI  05/30/2014  Revision to CMS Publication 100-08,  07/31/2014 8512 
Chapter 15 
R517PI  05/16/2014  Update to Surety Bond Collection  06/17/2014 8636 
Procedures 
R514PI  05/02/2014  Update to CMS Publication 100-08,  06/03/2014 8682 
Chapter 15 
R509PI  03/27/2014  Change in Provider Enrollment  06/02/2014 8551 
Timeliness Standards 
R507PI  02/28/2014  Change in Provider Enrollment  05/29/2014 8551  Rev #  Issue Date  Subject  Impl Date  CR# 
Timeliness Standards  Rescinded and 
replaced by Transmittal 509 
R503PI  01/24/2014  Inter-Jurisdictional Reassignments  02/25/2014 8545 
R502PI  01/17/2014  Registration of Entities Using the Indirect 01/06/14  8284 
Payment Procedure (IPP) 
R499PI  12/27/2013  Update to Chapter 15 of the Program  01/28/2014 8544 
Integrity Manual 
R494PI  12/06/2013  Registration of Entities Using the Indirect 01/06/14  8284 
Payment Procedure (IPP) 
R492PI  12/06/2013  Additional Updates to Chapter 15 of the  01/07/2014 8393 
Program Integrity Manual (PIM) 
R490PI  11/06/2013  Reassignment to Part A Critical Access  01/06/2014 8387 
Hospitals Billing Under Method II (CAH 
II) 
R483PI  08/16/2013  Reassignment to Part A Critical Access  01/06/2014 8387 
Hospitals (CAHs), Federally Qualified 
Health Centers (FQHCs), and Rural 
Health Clinics (RHCs)  Rescinded and 
replaced by Transmittal 490 
R479PI  08/01/2013  Enrollment Denials When an Existing or  10/07/2013 8039 
Delinquent Overpayment Exists 
R478PI  08/02/2013  Registration of Entities Using the Indirect 01/06/2014 8284 
Payment Procedure (IPP)  Rescinded 
and replaced by Transmittal 494 
R474PI  07/05/2013  Update to Chapter 15 of the Program  10/08/2013 8341 
Integrity Manual (PIM) 
R471PI  06/11/2013  Update to Chapter 15 of the Program  05/28/2013 8222 
Integrity Manual (PIM) 
R470PI  05/31/2013  Revision to Surety Bond Collection  07/01/2013 8283 
Process 
R469PI  05/31/2013  Enrollment Denials When an Existing or  10/07/2013 8039 
Delinquent Overpayment Exists  
Rescinded and replaced by Transmittal 
479 
R463PI  05/17/2013  Model Letter Revisions  06/07/2013 8117 
R462PI  05/16/2013  Update to Chapter 15 of the Program  03/18/2013 8155 
Integrity Manual (PIM) 
R461PI  04/26/2013  Update to Chapter 15 of the Program  05/28/2013 8222 
Integrity Manual (PIM)  Rescinded and  Rev #  Issue Date  Subject  Impl Date  CR# 
replaced by Transmittal 471 
R459PI  04/12/2013  Tax Identification Numbers of Foreign  05/13/2013 8258 
Owning and Managing Entities and 
Individuals 
R457PI  04/02/2013  Model Letter Revisions  Rescinded and  04/22/2013 8117 
replaced by Transmittal 463 
R456PI  03/22/2013  Model Letter Revisions  Rescinded and  04/22/2013 8117 
replaced by Transmittal 457 
R450PI  02/15/2013  Update to Chapter 15 of the Program  03/18/2013 8155 
Integrity Manual (PIM)  Rescinded and 
replaced by Transmittal 462 
R445PI  12/14/2012  Revision to Section 15.5.20 of Chapter 15 01/01/2014 7864 
of the Program Integrity Manual (PIM) 
R440PI  11/23/2012  Revisions to Appeals Section of Chapter  12/24/2012 8110 
15 of the Program Integrity Manual 
(PIM) 
R437PI  11/02/2012  Revision to Section 15.5.20 of Chapter 15 02/01/2013 7864 
of the Program Integrity Manual (PIM)  
Rescinded and replaced by Transmittal 
445 
R435PI  10/19/2012  General Update to Chapter 15 of the  11/20/2012 8019 
Program Integrity Manual (PIM)-Part IX 
R433PI  09/07/2012  Review of Debarment List and  10/09/2012 8020 
Processing of Tie-in Notices 
R431PI  08/31/2012  Ordering and Certifying Documentation- 10/01/2012 7890 
Maintenance Requirements 
R430PI  09/28/2012  General Update to Chapter 15 of the  10/29/2012 7889 
Program Integrity Manual (PIM)-Part 
VIII 
R424PI  06/13/2012  General Update to Chapter 15 of the  06/19/2012 7827 
Program Integrity Manual (PIM)-Part VI 
R423PI  06/01/2012  General Update to Chapter 15 of the  07/02/2012 7839 
Program Integrity Manual (PIM)-Part VII 
R421PI  05/18/2012  General Update to Chapter 15 of the  06/19/2012 7827 
Program Integrity Manual (PIM)-Part VI 
 Rescinded and replaced by Transmittal 
424 
R416PI  04/13/2012  General Update to Chapter 15 of the  02/27/2012 7698 
Program Integrity Manual (PIM)-Part III  Rev #  Issue Date  Subject  Impl Date  CR# 
R415PI  04/13/2012  General Update to Chapter 15 of the  05/14/2012 7797 
Program Integrity Manual (PIM)-Part V 
R414PI  04/06/2012  General Update to Chapter 15 of the  05/07/2012 7763 
Program Integrity Manual (PIM)-Part IV 
R412PI  03/30/2012  General Update to Chapter 15 of the  04/30/2012 7646 
Program Integrity Manual (PIM)-Part II 
R410PI  03/02/2012  Instructions for Processing Form CMS- 06/04/2012 7723 
855O Submissions 
R408PI  02/22/2012  Additional Provider and Supplier  02/03/2012 7363 
Enrollment Requirements for Fixed Wing 
and Helicopter Air Ambulance Operators 
R407PI  02/09/2012  Advanced Diagnostic Imaging (ADI)  01/27/2012 7681 
Accreditation Enrollment 
Procedures(This CR Fully Rescinds and 
Replaces CR 7177) 
R405PI  01/26/2012  General Update to Chapter 15 of the  02/27/2012 7698 
Program Integrity Manual (PIM) Part III 
 Rescinded and replaced by Transmittal 
416 
R404PI  01/20/2012  General Update to Chapter 15 of the  04/22/2012 7579 
Program Integrity Manual (PIM)-Part I 
R403PI  01/20/2012  Claims Against Surety Bonds for  02/21/2012 7167 
Suppliers of Durable Medicare 
Equipment, Prosthetics. Orthotics and 
Supplies (DMEPOS) 
R402PI  01/13/2012  Advanced Diagnostic Imaging (ADI)  01/27/2012 7681 
Accreditation Enrollment 
Procedures(This CR Fully Rescinds and 
Replaces CR 7177)  Rescinded and 
replaced by Transmittal 407 
R400PI  11/21/2011  Additional Provider and Supplier  02/03/2012 7363 
Enrollment Requirements for Fixed Wing 
and Helicopter Air Ambulance Operators 
 Rescinded and replaced by Transmittal 
408 
R394PI  10/27/2011  Additional Provider and Supplier  02/03/2012 7363 
Enrollment Requirements for Fixed Wing 
and Helicopter Air Ambulance Operators 
 Rescinded and replaced by Transmittal 
400 
R392PI  10/14/2011  Update to Notifications Sent to State  11/15/2011 7532  Rev #  Issue Date  Subject  Impl Date  CR# 
Medicaid Agencies and Child Health 
Plans of Medicare Terminations for 
Certified Providers and Suppliers and 
Medicare Revocations for Providers and 
Suppliers. This CR rescinds and fully 
replaces CR 7017, 7074 and 7334 
R388PI  09/16/2011  Additional Review Activities for Home  12/17/2011 7525 
Health Agencies (HHAs) 
R387PI  09/01/2011  Eligible Physicians and Practitioners  10/18/2010 7097 
Who Need to Enroll in the Medicare 
Program for the Sole Purpose of Ordering 
and Referring Services for Medicare 
Beneficiaries 
R380PI  08/03/2011  Advanced Diagnostic Imaging  07/05/2011 7177 
Accreditation Enrollment Procedures 
R374PI  05/06/2011  Update to Notifications Sent to State  06/06/2011 7334 
Medicaid Agencies and Child Health 
Plans of Medicare Terminations for 
Certified Providers and Suppliers and 
Medicare Revocations for Providers and 
Suppliers 
R373PI  04/07/2011  Advanced Diagnostic Imaging  07/05/2011 7177 
Accreditation Enrollment Procedures  
Rescinded and replaced by Transmittal 
380 
R372PI  03/25/2011  Effective Date of Certified Provider or  04/25/2011 7232 
Supplier Agreement or Approval 
R371PI  03/23/2011  Implementation of Provider Enrollment  03/25/2011 7350 
Provisions in CMS-6028-FC 
R369PI  03/11/2011  Advanced Diagnostic Imaging  06/12/2011 7177 
Accreditation Enrollment Procedures  
Rescinded and replaced by Transmittal 
373 
R365PI  01/28/2011  Diabetes Self-Management Training  04/29/2011 7236 
(DSMT) 
R363PI  01/14/2011  Clarification for Part A Contractors  02/15/2011 7221 
Including Audit and Claims 
Intermediaries Notifying Each Other via 
E-mail Upon Processing of the Initial 
Enrollment Application, Change of 
Information, Voluntary Termination, or  Rev #  Issue Date  Subject  Impl Date  CR# 
Any Other CMS-855 Transaction 
R358PI  10/29/2010  Indian Health Service (IHS) Facilities and 11/29/2010 7174 
Tribal Providers Use of Internet-based 
Provider Enrollment, Chain and 
Ownership System (PECOS) 
R357PI  10/01/2010  Durable Medical Equipment (DME  10/04/2010 6714 
MAC) and the National Supplier 
Clearinghouse (NSC MAC) Procedures 
for Third Party Notification of Deceased 
Durable Medical Equipment, Prosthetic, 
Orthotic and Supplies (DMEPOS) 
Supplier Associates 
R356PI  09/24/2010  Manual Redesign  10/26/2010 7083 
R355PI  09/17/2010  Eligible Physicians and Practitioners  10/18/2010 7097 
Who Need to Enroll in the Medicare 
Program for the Sole Purpose of Ordering 
and Referring Services for Medicare 
Beneficiaries 
R354PI  08/27/2010  Manual Redesign  09/28/2010 7016 
R353PI  08/27/2010  Notification to State Medicaid Agencies  09/28/2010 7074 
and Child Health Plans of Medicare 
Terminations for Certified Providers and 
Suppliers 
R350PI  08/20/2010  Notification to State Medicaid Agencies  09/21/2010 7017 
and Child Health plans of Medicare 
Revocation 
R347PI  07/15/2010  Chapter 10 Manual Redesign - Initial  07/30/2010 6938 
release of Chapter 15 
R346PI  06/25/2010  Guidance on Implementing Section 3109  01/03/2011 7021 
of the Patient Protection and Affordable 
Care Act (PPACA) 
R344PI  06/18/2010  Chapter 10 Manual Redesign - Initial  07/05/2011 6938 
release of Chapter 15 - Rescinded and 
replaced by Transmittal 347 
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