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 website 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