Official Federal Forms
Centers For Medicare And Medicaid Services
Last updated: 10/8/2024
Medicare Enrollment Application Institutional Providers {CMS-855A}
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Description
CMS-855A - MEDICARE ENROLLMENT APPLICATION INSTITUTIONAL PROVIDERS. This application is essential for institutional providers seeking enrollment in the Medicare program and obtaining a Medicare billing number. It applies to a range of healthcare organizations such as hospitals, hospices, skilled nursing facilities, and various specialized clinics. Providers can apply or update enrollment information using the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or the CMS-855A paper form. Requirements include having a Type 2 NPI and ensuring the use of the current CMS-855A version. Providers must use this application for initial enrollment, reporting changes, revalidating enrollment, reactivating billing numbers, or terminating enrollment. Specific instructions are provided for reporting changes of ownership, acquisitions/mergers, consolidations, and voluntary terminations. www.FormsWorkFlow.com
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