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PDF 855B Enrollment & Policy Overview

What is the 855B? The CMS form used for the enrollment of Clinic/Group practices and Certain Other Suppliers This form is also used to submit changes to your enrollment data Benefits of using PECOS vs Paper We encourage you to use PECOS instead of paper Medicare enrollment applications Advantages of using PECOS include:

PDF REASSIGNMENT OF MEDICARE BENEFITS HTTPS://PECOSCMSHHS

enrolling via submission of the CMS-855B for the eligible organization/group and the CMS-855I for the individual practitioner) in the Medicare program before the reassignment can take effect Generally this application is completed by the organization/group signed by the Delegated/Authorized Official of the organization/group and

PDF MEDICARE ENROLLMENT APPLICATION

CMS-855B (Rev 03/2021) 1 WHO SHOULD SUBMIT THIS APPLICATION Clinics group practices and other suppliers must complete this application to enroll in the Medicare program and receive a Medicare billing number

PDF Medicare Enrollment Application

Clinics and group practices who are enrolled in the Medicare program but have not submitted the CMS 855B since 2003 are required to submit a Medicare enrollment application (i e Internet-based PECOS or the CMS 855B) as an initial application when reporting a change for the first time

  • Do I need a CMS 855b enrollment application?

    If you provide health care services in more than one State and those States are serviced by different Medicare fee-for-service contractors, complete a separate CMS-855B enrollment application for each Medicare fee-for-service contractor’s jurisdiction. If you are adding or deleting an entire State, it is not necessary to report each city/town.

  • Do I need a cms-588 form if I'm not receiving Medicare payments?

    (IDTF changes of information must comply with the provisions found at 42 C.F.R. § 410.33.) If you are already enrolled in Medicare and are not receiving Medicare payments via EFT, any change to your enrollment information will require you to submit a CMS-588 form. All future payments will then be made via EFT.

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