Medicare Part A Provider Enrollment

To receive Medicare payments for covered services provided to Medicare beneficiaries, health care providers must first enroll in the Medicare program by completing the “Medicare Enrollment Application for Institutional Providers” form (CMS-855A). 

Refer to the following resources to ensure accurate submission of the CMS-855A.

  • Provider Enrollment Packet — Provides assistance in completing an accurate CMS-855A application and explains the application review process.
  • Electronic CMS-855A Globe to indicate www link. — The CMS-855A form is available on the Centers for Medicare & Medicaid Services (CMS) Web site in a format, which allows you to complete the application using Adobe Acrobat and save the information on your personal computer or download the application.
  • Electronic Funds Transfer (EFT) — If your facility is not already receiving payments directly into your facility’s bank account, the “Agreement for Electronic Funds Transfer (EFT)” form must be submitted with the CMS-855A application.
  • Electronic Data Interchange (EDI) — Provides information about submitting your Medicare claims electronically.
  • Frequently Asked Questions — Provides answers to questions about change of ownership, claim and audit intermediaries, National Provider Identifier (NPI), and electronic funds transfer (EFT).
  • Tips for Completing the CMS-855A Enrollment Application — This resource is intended for those who complete a full CMS-855A, and mainly applies to providers that are filing due to Revalidation or Reactivation.  This is also helpful to facilities that are required to file a full CMS-855A enrollment application since the Provider Enrollment Chain and Ownership System (PECOS) was implemented, July 29, 2002. 

In addition to the initial enrollment to the Medicare program, a CMS-855A application is required for the following requests:

  • Change of Ownership, Acquisition/Merger, or Consolidation
  • Stock Transfer or Reorganization
  • Additional Branch Location
  • 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

The Medicare fee-for-service contractor servicing your State or jurisdiction will review/process your enrollment application. If Cahaba does not service your State or jurisdiction, refer to the CMS Web site for a map of fiscal intermediaries, Globe to indicate www link. RHHIs (regional home health intermediaries), Globe to indicate www link. and Medicare administrative contractors (MACs), Globe to indicate www link. and a list of provider-supplier enrollment contacts Globe to indicate www link. to determine the appropriate contractor.

Go to the Contact Us page for information about where to submit the completed CMS-855A and supporting documentation.

Page last updated: September 5, 2008

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