Last Modified: 10/14/2021
Location: FL, PR, USVI
Business: Part B
Q: What applications do we complete to add a provider to our group?
The CMS-855I may be used to add a provider who is initially enrolling or making changes to that provider’s personal information. The CMS-855R is used to reassign the individual’s benefits to the group. This information can also be captured in internet-based PECOS. For more information on the paper enrollment forms and internet-based PECOS, please review the page Understanding which CMS-855 form to complete
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.