Provider Enrollment - Some basic question on ownership and disclosing information

What does disclosing entity mean?

Disclosing Entity means a Medicaid provider (other than an individual practitioner), or a fiscal agent.

What does Publicly Owned mean?
In the United States, a publicly owned corporation is one whose shares are traded on public stock exchanges. Generally, anyone may purchase shares in such a corporation.

What does Privately Owned mean?
A privately owned corporation does not offer or trade its shares to the public on public stock exchanges.

What if there are no owners who have a 5% or more controlling interest in a publicly owned company?
In the PEAP system you would indicate YES where it states: “If the provider entity is a publicly held corporation and no person owns 5% or more of the corporation, you must select "Yes," and you must provide information for board members, agent(s) and managing employee(s). (Local, county and state government entities must select "No.")

What does managing employee mean?
Managing employee means a general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of an institution, organization, or agency.

What is the definition of an Agent?
Any person who has been delegated the authority to obligate or act on behalf of a provider.

What does ownership or controlling interest mean?

Ownership interest means the possession of equity in the capital, the stock, or the profits of the disclosing entity.

A person with an ownership or controlling interest means a person or corporation that—
a. Has an ownership interest totaling 5% or more in a disclosing entity;
b. Has an indirect ownership interest equal to 5% or more in a disclosing entity;
c. Has a combination of direct and indirect ownership interests equal to 5% or more in a disclosing entity;
d. Owns an interest of 5% or more in any mortgage, deed of trust, note, or other obligation secured by the disclosing entity if that interest equals at least 5% of the value of the property or assets of the disclosing entity;
e. Is an officer or director of a disclosing entity that is organized as a corporation or is a partner in a disclosing entity that is organized as a partnership.


What does indirect ownership interest mean?
Indirect ownership interest means an ownership interest in an entity that has an ownership interest in the disclosing entity. This term includes an ownership interest in any entity that has an indirect ownership interest in the disclosing entity.

Can a CEO be listed as a board member? 

Yes, if he/she serves on the board.
I have a physician who is owner and board member and who has also designed a component that is used in surgical procedures. Should I disclose that information, as he receives royalties for that, and we bill Medicaid for that component?
Yes.


What if I have a board member who is also an owner? How should I enter this person’s information?
The board member must be listed as both.
How do I know what my taxonomy code is?
You can obtain your taxonomy code from the letter you received to begin your revalidation. This letter also provided your Case Number for entering the Provider Enrollment Application Portal (PEAP).

What is a subcontractor?

(1) An individual, agency, or organization to which a disclosing entity has contracted or delegated some of its management functions or responsibilities of providing medical care to its patients; or (2) An individual, agency, or organization with which an intermediary or carrier has entered into a contract, agreement, purchase order or lease (or leases of real property) to obtain space, supplies, equipment, or services provided under the Medicare agreement.

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