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Last Modified: 12/21/2017 Location: FL, PR, USVI Business: Part A, Part B

When to complete a new CMS-855

Q: When do I need to complete a new CMS-855?
A. You need to complete a new CMS-855 when:
An individual or entity is requesting initial enrollment into the Medicare program.
Changes are being submitted to update enrollment information and the individual or entity does not have a completed enrollment application (CMS-855) on file.
An individual or entity is submitting a request for Electronic Funds Transfer (EFT) and an enrollment application is not on file.
Access the Provider Enrollment Application Assistance Tool for more help in determining the appropriate enrollment form for submission.
Note: For more information about revalidation requests, please refer to our Revalidations FAQs.
Source: The Centers for Medicare & Medicaid Services (CMS) internet-only manual (IOM) publication 100-08, chapter 15 external pdf file
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.