How to complete a CMS-855 form

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Home ► faqs ► answers ► How to complete a CMS-855 form

Last Modified: 9/28/2021 Location: FL, PR, USVI Business: Part A, Part B

How to complete a CMS-855 form

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 offers several online resources to assist you during the provider enrollment process including:

• CMS-855 tutorials

• Provider enrollment Learning on Demand Center playlist -- View webinars, videos, and more

• Provider enrollment tips, terms, and specialty codes:

• Tips to expedite your Medicare enrollment process

• Commonly used provider enrollment terms and their definitions

• Medicare provider/supplier specialty codes

Access the Provider Enrollment Application Assistance Tool for more help in determining the appropriate enrollment form and documentation for submission.

Note: CMS approved two new enrollment forms, CMS-855C and CMS-855POH. For more information, access the change request (CR) 9120 external pdf file

and the CMS Forms List external link

page.

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