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Last Modified: 10/27/2020 Location: FL, PR, USVI Business: Part B

Reassignment of Medicare benefits: Revised CMS-855R required May 1

Physicians and non-physician practitioners: Use the revised CMS-855R (Reassignment of Benefits) application posted on the CMS forms list in early February 2020. Medicare administrative contractors will accept only revised versions of the form effective May 1, 2020. Form updates:
Can select “Change of Reassignment Information” as submission reason
Option to identify a secondary practice address
Visit the Medicare Provider-Supplier Enrollment external link webpage for more information about Medicare enrollment.
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.