What attachments should be submitted with the application?

Answer:
Below are the attachments required to be submitted for application processing on the hard copy CMS 855s or via PECOS. Please note the NPWest has the authority to request other types of documentation if needed to confirm compliance with Medicare guidelines.

• All licenses required by the state or federal governments to operate the business. For more information on required licenses, please review the Licensure Database.
• Suppliers are required to list their National Provider Identifier (NPI) on the application and submit a copy of the notification furnished by the National Plan and Provider Enumeration System (NPPES) verifying the NPI. Suppliers should always list their NPI on the CMS 855S and submit a copy of the notification for new applications, additional locations and reactivations. Further, the notification must list the business name and physical address of the location as reported. The legal business name as reported to the NPWest must be an exact match with the IRS documentation.
• Suppliers who are new enrollees or submitting an application for an additional location are required to submit the authorization agreement for electronic funds transfer (CMS 588). In addition either a voided check or a letter on bank letterhead verifying the account information must be included with the completed form. Further, suppliers changing information or revalidating are asked to submit the CMS 588 form if not already receiving payments electronically.
• Proof of at least $300,000 in general liability insurance coverage. Submitting the certificate of insurance is acceptable but it must list the type of coverage, amount of coverage, effective dates and the location(s) covered. Also, the NPWest must be listed as the certificate holder.
• If initially enrolling or changing the tax id number submit a document from the IRS showing the legal name of the entity and federal tax identification number. 
• Suppliers should also submit a valid surety bond in the amount of at least $50,000 unless the supplier type is otherwise exempt from this requirement for new locations, additional locations and reactivations.
• Suppliers should also verify accreditation information has been properly reported to the NPWest by the accrediting organization.