Changes to Required Documentation for Provider Record Updates

Changes to Required Documentation for Provider Record Updates 

Effective Nov. 13, 2019, IRS W-4 form copies are no longer accepted as a source of required documentation to update a Social Security number (SSN) on provider records. However, a copy of an IRS W-2 form is now accepted. Please refer to the chart below for an updated list of required documentation for changes to a provider’s record. 

It is critical that correct names, dates of birth (DOB), and SSNs are entered on all applications, including initial enrollment, re-enrollment, manage change requests and re-verification. Submitting applications with inaccurate or invalid data can cause the application to be withdrawn. If the application is withdrawn, a new application must be submitted with the correct information and will require all appropriate application fees.

The process for updating this information is not the same for all roles. Managing employees (MEs) and owner’s name, DOB, and SSN can be updated on a re-enrollment or re-verification application or with a manage change request (MCR). The office administrator (OA) or provider’s name, DOB, or SSN can only be updated by an NCTracks enrollment specialist with the proper documentation.

How to Update the Name, DOB, and/or SSN for the Provider or OA 
 

Currently enrolled providers and OAs (including MEs that are also the OA) are unable to make changes to their name, DOB, and/or SSN. These changes or updates must be made by an NCTracks enrollment specialist.

When the NCTracks enrollment specialist receives background information indicating that the name, DOB or SSN may be incorrect on the application, the provider or OA is sent an “application incomplete” letter requesting verification of the name, DOB and/or SSN. 

  • If verification is received by an NCTracks enrollment specialist that confirms the application and the provider’s record are correct, the application will continue to be processed. 
  • If verification is received by an NCTracks enrollment specialist that confirms the application is incorrect, the application will be withdrawn. The provider must resubmit the application with the correct information and pay all appropriate application fees.

NOTE: If the verification confirms that the information in the provider’s active record is incorrect, the NCTracks enrollment specialist will correct the name, DOB, and/or SSN on the provider’s record based on the legal documents received; however, the currently submitted application will still be withdrawn.


How to Update the Name, DOB, and/or SSN for Owners and MEs   
 

Currently enrolled owners and MEs ( who are not also the OA) can update or change their name, DOB, and/or SSN on the re-enrollment or re-verification application or with an MCR. The information can be updated by end-dating the line containing the incorrect information and adding a new line with that individual’s correct information.
 

How to Update Name, DOB, and/or SSN for an OA  who is also a ME

If the OA is also listed as a ME, and their name, SSN, and/or DOB needs to be updated, the NCTracks enrollment specialist must make these changes on behalf of the provider with the proper documentation.
 

How to Update Name, DOB, and/or SSN on an Initial Enrollment Application

Initial enrollment applications with an incorrect name, DOB, and/or SSN must be withdrawn. When the NCTracks enrollment specialist receives background information indicating that the name, DOB, and/or SSN may be incorrect on the application, the provider or OA is sent an “application incomplete” letter requesting verification of the name, DOB and/or SSN. 

  • The provider can withdraw the application if they know the information on it is incorrect. The provider must resubmit the application and pay all appropriate application fees.
  • If verification is received by NCTracks enrollment specialist that confirms that the information on the application is correct, the application will continue to be processed. 
  • If verification is received by NCTracks enrollment specialist that confirms the information on the application is incorrect, the application will be withdrawn and must be resubmitted with the correct information and will require all appropriate application fees.
     

How the provider, OA, and/or owner(s) can see if their information is correct on the record. 

For security purposes, only the last four digits of the SSN are visible to the currently enrolled provider, owner, ME and OA listed on the record. NCTracks call center agents are unable to give this information over the phone. However, providers may provide the call center agent the name, DOB, or SSN they have and ask if it matches what is shown on the provider record. The call center agent can confirm yes or no as to whether it matches the record.
 

Type of Change

Required Documentation

Individual legal name

 

 

 

 

 

 

  • Copy of State-issued driver’s license
  • Copy of passport
  • Copy of marriage certificate or legal name change document reflecting correct name 
  • Copy of Medicare card
  • Copy of military ID card

Date of birth

  • Copy of State-issued driver’s license
  • Copy of passport
  • Copy of military ID card

 

Note: If the DOB is incorrect for a managing employee or owner, it can be changed through an MCR by end-dating the incorrect information. Credentialing may be required.  

Social Security number

  • Copy of Social Security card
  • SSA-1099 (Social Security Administration – 1099) or Non-SSA-1099 (Non-Social Security Administration – 1099)
  • Copy of military ID card
  • Copy of IRS W-2 form
  • Pay stub (full name and SSN must show on stub)

 

Note: If the SSN is incorrect for a managing employee or owner, it can be changed through an MCR by end-dating the incorrect information. Credentialing may be required.

Gender

  • Copy of State-issued driver’s license
  • Copy of birth certificate
  • Copy of military ID card

Organization/group legal name

  • Copy of IRS letter

Employer Identification Number (EIN)

 

  • Copy of IRS Letter reflecting the correct EIN

 

Note: The IRS letter only needs to be submitted if the EIN change is NOT due to a change of ownership (CHOW). If the EIN change is due to a CHOW, the provider should terminate the current record with the CHOW reason code and then enroll the new record with the new EIN.

 

NOTE: Providers who submit documents that have expiration dates, such as a driver’s license or passport, must submit valid, current copies. For example, an expired driver’s license is not considered valid or current, and as a result, is not an acceptable document submission.