Last Modified: 3/13/2018 Location: FL, PR, USVI Business: Part A, Part B
Multi-practice group FAQs
Q: I work for three multi-practice groups, and a separate revalidation request letter was sent to each of the three practice addresses. Do I have to submit three separate enrollment applications (CMS-855I) and three reassignment (CMS-855R) applications?
A: Complete and submit one CMS-855I by downloading the form or submitting through Internet-based Provider Enrollment, Chain, and Ownership System (PECOS). Ensure to complete Section 4B where you will need to identify all of your current reassignment of benefits to groups in which you are still working.
Note: First Coast Service Options Inc. (First Coast) must receive all applications by the Centers for Medicare & Medicaid Services established due date found online at https://data.cms.gov/revalidation , or Medicare payments will be withheld, and billing privileges will be deactivated. You will be required to submit your enrollment application to reactivate your billing privileges.
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