CMS-855

The family of Medicare enrollment application forms used to enroll providers, suppliers, and organizations in the Medicare program through PECOS.

The CMS-855 forms are the official Medicare enrollment applications. There are several versions, and using the wrong one is a common mistake that delays enrollment. CMS-855I is for individual providers: physicians, nurse practitioners, physician assistants, therapists, and other individual healthcare professionals. This is the form you file to get your own Medicare provider number. CMS-855B is for group practices and clinics. If you are a multi-provider practice that bills under a group NPI and tax ID, you need an 855B for the group entity in addition to 855I forms for each individual provider in the group. CMS-855A is for institutional providers like hospitals, skilled nursing facilities, home health agencies, and ambulatory surgical centers. CMS-855S is for DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) suppliers. CMS-855O is for ordering and referring physicians who need to be in PECOS to order or refer Medicare services but do not bill Medicare directly. The 855 forms ask for detailed information about you and your practice: personal identification, medical education and training, licensure, practice locations, managing employees and owners with 5% or greater ownership interest, billing arrangements, and adverse action history. A critical section that many providers overlook is the reassignment of benefits section. If you are an individual provider billing through a group practice, your 855I must include a reassignment of benefits to the group's 855B. Without this linkage, your claims will deny. All 855 forms can be submitted electronically through PECOS, which is strongly recommended over paper submission. Electronic submissions are processed faster and you can track the status online. Paper submissions go into a scanning queue and take longer to enter the system. Keep copies of everything you submit. When your MAC comes back with a development request asking for clarification, you need to know exactly what you originally submitted.