Last Modified: 6/19/2018
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 
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