Provider Enrollment Packet
Cahaba’s “Provider Enrollment Packet” offers assistance in completing an accurate CMS-855A. The CMS-855A Medicare enrollment application must be completed when enrollment information needs to be added, deleted, or changed. This includes:
- Changing Existing Medicare Information—Currently Enrolled Providers
- Additions, Deletions, and Changes of Address
- Managing/Directing Employee Change
- Authorized/Delegated Official Change
- Transfer of Stock
- Note that in conjunction with any change submitted on the CMS-855A or 588 form, a full CMS-855A may be required if the provider has not submitted an application since implementation of the Provider Enrollment Chain and Ownership System (PECOS) on July 29, 2002
- Initial Enrollment Resulting in Issuance of a Medicare Provider Number
- Home Health Agency Capitalization Requirements
- Voluntary Termination
- Changes of Ownership (old and new owner)
- Acquisitions and Mergers (acquiring and acquired owners)
- Consolidations (consolidating owners and newly created provider)
- Revalidation (contractor requested or voluntary)
- Reactivation of previously deactivated provider number
Access the following:
- CMS-855A
application and instructions
— Available on the
Centers for Medicare & Medicaid Services (CMS) Web site and can
be completed on-line or can be downloaded to complete manually. - CMS-855A Provider Enrollment Process Checklist — Ensures all steps in the process have been completed (applicable to all types of submissions).
- CMS-855A Provider Enrollment Submission Checklist — A checklist with step-by-step instructions for completing the application (applicable for only home health and hospice providers).
- Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588) Form
— Allows Medicare to transfer payments to your facility’s financial
institution. Must be completed for new enrollments. For
enrolled providers, if not already receiving EFT, the CMS-588 EFT
form must be completed when requesting an enrollment change. The
CMS-588 EFT form must be submitted with the CMS-855A application. Refer
to Cahaba’s Electronic Funds Transfer (EFT) Web page for additional information. - Provider Enrollment Review Process — Refer to this Web page for an explanation of the process used to review the CMS-855A enrollment application.
Additional Resources
- CMS
Provider Enrollment Web site

- Provider Enrollment Frequently Asked Questions provides answers to frequently asked questions about provider enrollment.
- Medicare
Learning Network Medlearn Matters Articles
provides articles designed
to inform the physician, provider, and supplier community about the
latest changes to the Medicare Program. - Provider
Enrollment in the Medicare Program

- Announcing
the Release of the Revised CMS-855 Medicare Enrollment Applications

- Medicare
Enrollment for Institutional Providers Brochure
provides an overview
of the enrollment process. - Electronic Data Interchange (EDI) provides the electronic billing agreement and instructions.
- Medicare
Program Integrity Manual, (CMS Pub.100-08), Chapter 10

- State
Operations Manual

- Fraud Detection and Prevention
Page last updated: May 17, 2010