Last Modified: 5/22/2020
Location: FL, PR, USVI
Business: Part A, Part B
Q: How do I complete a CMS-855 form? How can I be sure that I have everything I need?
A: Medicare enrollment applications/forms (CMS-855A, CMS-855B, CMS-855I, and CMS-855R) must be completed with accurate information and include all supporting documentation.
First Coast Service Options Inc. (First Coast) offers several online resources
to assist you during the provider enrollment process including:
• Clinics/group practices and certain other suppliers: CMS-855B • Physicians and non-physician practitioners: CMS-855I
• Provider enrollment tips, terms, and specialty codes:
The Centers for Medicare & Medicaid Services approved two new enrollment forms, CMS-855C and CMS-855POH. For more information, access the change request (CR) 9120
and the CMS Forms List
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to return to the referring page.
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.