The Centers for Medicare & Medicaid Services has established requirements and procedures for handling provider information change.
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 Part A Enrollment Packet.
Where to Submit Correspondence
Completed applications or other correspondence related to Part A Medicare Enrollment may be mailed to the following address:
Cahaba Medicare Part A
Post Office Box 6168
Indianapolis, IN 46206-6168