Has your organization been instructed to file a CMS-855A application?
Everyone is talking about this form, but what is it?
The information provided on this Web site is intended to familiarize your organization with information contained on the CMS-855A Medicare Federal Health Care Provider Enrollment Application for Health Care Providers that Bill the Medicare Fiscal Intermediary and the Medicare Part A Provider Enrollment process. For more background, we invite you to learn more about Medicare Provider Enrollment.
Did you receive a letter requiring your facility to file a CMS-855A as part of the Revalidation, Reactivation or the “Medicare Provider Enrollment Demonstration for Home Health Agencies (HHAs) in High-Risk Areas” process? View our tips to help in the completion of the full 855A to ensure an accurate submission.
Already familiar with the process?
For new CMS-855A filers
- Is your organization a Part A Medicare provider? If yes, continue to the next step.
- Is Cahaba (GBA) your organization’s Medicare Administrative Contractor? Refer to the CMS website for a map of A/B Medicare Administrative Contractors (MAC) to determine the appropriate servicing A/B MAC.
Does your organization need to file a request for one of the following?
- Initial Medicare Enrollment
- Change of Ownership, Acquisition/Merger, or Consolidation
- Stock Transfer or Reorganization
- Conversion to Critical Access Hospital
- Additional Branch Location, including provider-based
- Reactivation of a Previously Deactivation Medicare Provider Number
- Change of Information for:
- Legal Business or Doing Business As Name
- Pay-to Address
- Electronic Funds Transfer (EFT) Address
- Correspondence/Practice Location Address
- Managing/Directing Employee Change
- Phone/Fax Number Change
- Billing Agency
If so, a CMS-855A application is required. You’ll find more information in the the Provider Enrollment Packet
Go to the Contact Us page for information about where to submit the completed CMS-855A and supporting documentation.
Additional Section Links
- Provider Enrollment Introduction
- About Medicare Provider Enrollment
- Provider Enrollment Packet
- Provider Enrollment Frequently Asked Questions
- Provider-Based Status Determinations
- Provider-Based Status Background
- Electronic Funds Transfer (EFT)
- Electronic Data Interchange (EDI)
Page last updated: September 23, 2008