Privacy Act of 1974; Report of New System of Records

Streszczenie

In accordance with the requirements of the Privacy Act of 1974, we are proposing to establish a new SOR titled, "Provider Enrollment, Chain, and Ownership System (PECOS)," HHS/CMS/OFM, System No. 09-70-0532. PECOS will be used to collect and maintain provider/ supplier enrollment information from the Medicare Provider/Supplier Enrollment Application and related forms (Form(s) HCFA-855A, 855B, 855I, 855R, and, 855S). PECOS will collect information provided by the applicant related to identity, qualifications, practice locations, ownership, billing arrangements, reassignment of benefits, surety and bond data, clearinghouses submitting electronic claims, and related organizations. PECOS will also maintain information on business owners, chain home offices and provider/chain associations, managing/directing employees, partners, authorized and delegated representatives, supervising physicians of the supplier, staffing companies, ambulance crew members, and/or interpreting physicians and related technicians. Managing/directing employees include general managers, business managers, administrators, directors, and other individuals who exercise operational or management control over the pro