cms 855a revalidation


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PDF REVALIDATION APPLICATION CHECKLIST

REVALIDATION APPLICATION CHECKLIST The below items shall be addressed prior to submitting your revalidation application Failure to address these items could result in a delay in processing your revalidation application INDIVIDUAL PROVIDERS

PDF INSTITUTIONAL PROVIDERS CMS-855A

• Revalidating your Medicare enrollment CMS may require you to submit or update your enrollment information The MAC will notify you when it is time for you to revalidate your enrollment information Do not submit a revalidation application until you have been contacted by the MAC

PDF 855A Enrollment & Policy Overview

What is the 855A? The Medicare Enrollment Application for Institutional Providers This form is also used to submit changes to your enrollment data 855A Initial Enrollment Process Provider Actions: Contact state agency for certification forms Complete CMS-855A and submit it to the MAC serving your state

  • Does my enrollment contractor send a revalidation notice?

    Yes. Your enrollment contractor will send a revalidation notice to you via email or U.S. postal mail about three to four months prior to your due date. Medicare Administrative Contractors (MACs) send revalidation notices to providers, group practices, and non-DMEPOS suppliers.

  • Do I need a separate cms-855a enrollment application?

    NOTE: If you provide mobile health care services in more than one state/territory and those states/territories are serviced by different MACs, complete a separate CMS-855A enrollment application for each MAC’s jurisdiction. 1. Initial Reporting and/or Additions

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