Last Modified: 11/19/2019
Location: FL, PR, USVI
Business: Part A, Part B
Q: I work for three multi-practice groups, and a separate revalidation request letter was sent to each of the three practice addresses. Do I have to submit three separate enrollment applications (CMS-855I) and three reassignment (CMS-855R) applications?
A: Complete and submit one CMS-855I by downloading the form or submitting through Internet-based Provider Enrollment, Chain, and Ownership System (PECOS). Ensure to complete Section 4F where you will need to identify all of your current reassignment of benefits to groups in which you are still working.
First Coast Service Options Inc. (First Coast) must receive all
applications by the Centers for Medicare & Medicaid Services established due date found online at https://data.cms.gov/revalidation
, or Medicare payments will be withheld
, and billing privileges will be deactivated
. You will be required to submit your enrollment application to reactivate your billing privileges.
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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.