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Commonly Asked Questions about 855i Application Forms

Why would a provider complete a CMS 855B form?

What is the 855B? ❖ The CMS form used for the enrollment of Clinic/Group practices and Certain Other Suppliers. This form is also used to submit changes to your enrollment data.

Who fills out the 855R?

The CMS-855R application is used by individual physicians and non-physician practitioners (hereafter collectively referred to as individual practitioners) who want to reassign their right to receive Medicare payments to another eligible individual or entity (i.e., sole proprietorship/clinic/group practice/other

What is the difference between an 855O and 855I?

CMS-855I: For employed physician assistants (sections 1, 2, 3, 13, and 15). CMS-855R: Individuals reassigning (entire application). CMS-855O: All eligible physicians and non-physician practitioners (entire application). Same applications are required as those of new enrollees.

What is the 855 form?

The primary function of the CMS Form 855 Medicare Enrollment Application is to gather information from. a provider or supplier that informs CMS regarding the provider, assists in the determination that the. provider meets certain qualifications to be a health care provider or supplier, where the provider.

What is an 855B Medicare form?

CMS 855B. Form Title. Medicare Enrollment Application - Clinics/Group Practices and Certain Other Suppliers.

What is the CMS 855I used for?

All physicians, as well as all eligible professionals as defined in section 1848(k)(3)(B) of the Social Security Act must complete this application to enroll in the Medicare program and receive a Medicare billing number.

What is an 855O Medicare enrollment?

CMS 855O. Form Title. Medicare Enrollment Application - Registration For Eligible Ordering and Referring Physicians and Non-Physician Practitioners.

What is the difference between 855I and 855B?

The difference between enrolling a practice using an 855I and 855B is the reporting of ownership information. When one individual owns the whole practice, Medicare can utilize the 855I to verify that the owner meets Medicare requirements.