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 (the steps in this checklist apply to each of the following
4 checklists)
- Additions, Deletions, and Changes of Address
- Managing/Directing Employee Change
- Authorized/Delegated Official Change
- Transfer of Stock
- Full CMS-855A (Provider has not submitted an application since implementation of PECOS onJuly 29, 2002, Voluntary Submission, Reactivation)
- 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)
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
- Medicare fraud and abuse prevention
Page last updated: September 10, 2008
