Last Modified: 9/19/2018
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 Service Options Inc. (First Coast) offers several online resources to assist you during the provider enrollment process including:
• Provider enrollment tips, terms, and specialty codes:
Access the Provider Enrollment Application Assistance Tool for more help in determining the appropriate enrollment form and documentation for submission.
Note: The Centers for Medicare & Medicaid Services approved two new enrollment forms, CMS-855C and CMS-855POH. For more information, access the change request (CR) 9120 
and the CMS Forms List 
page.
and the CMS Forms List page.
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