Reporting requirements for a legal business name (LBN) change

When an individual practitioner or a group / organization experience a change to their legal name or LBN, this change should be reported to the Medicare contractor within 90 days of the event.

Requests for name changes can be submitted on the Medicare Enrollment Application - Physicians and Non-Physician Practitioners (CMS-855I) (Section 2) for individuals or the Medicare Enrollment Application – Clinics / Group Practices and Other Suppliers (CMS-855B), Medicare Enrollment Application - Institutional Providers (CMS-855A), or Medicare Enrollment Application - Medicare Diabetes Prevention Program (MDPP) Suppliers (CMS-20134) based on specialty type (Section 2) for groups / organizations.

The individual's name must be updated at the Social Security Administration, National Plan & Provider Enumeration System (NPPES)  and National Provider Identifier (NPI) Registry before updating the Medicare file since the Provider Enrollment Chain and Ownership System (PECOS) connects to these databases.

Note: This is also the time to update the name with the state licensure branch.

We will verify that the LBN is correct by comparing it to other documents submitted with the application (i.e. Medicare Enrollment Application - Electronic Funds Transfer Agreement (CMS-588), the NPI Registry website, etc. Internal Revenue Service (IRS) documentation (i.e., CP-575, LTR 147C) is required to confirm the LBN change.

Please remember to submit an updated Electronic Funds Transfer (EFT) Agreement (CMS-588) to reflect the new name. This applies to groups, organizations, individuals in private practice, and sole proprietors.

Group members do not need to submit an EFT.