Cms 855i 2026

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The document is the Medicare Enrollment Application (CMS-855I) for physicians and non-physician practitioners. It outlines the process for enrolling in the Medicare program, including eligibility criteria, required documentation, and instructions for completing and submitting the application. The application is necessary for healthcare providers who wish to bill Medicare for services rendered, and it includes sections on personal information, practice location, managing control, adverse legal actions, and certification statements. Additionally, it emphasizes the importance of accurate information to avoid penalties for falsification.

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Click ‘Get Form’ to open the CMS 855i application in our platform's editor.
Begin with Section 1, Basic Information. Fill in your Medicare Identification Number and National Provider Identifier (NPI) as required.
Proceed to Section 2, Identifying Information. Enter personal details such as your name, date of birth, and social security number. Ensure all information matches your official records.
In Section 3, provide any final adverse legal actions or convictions if applicable. This section is crucial for compliance.
Move to Section 4 for Practice Location Information. List all practice locations where you will render services to Medicare beneficiaries.
Complete the Certification Statement at the end of the form by signing and dating it. Remember that only original signatures are accepted.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (55 Votes)
2011	4.4 Satisfied (236 Votes)
2006	4 Satisfied (38 Votes)

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

Starting November 1, 2023, you must use the revised form. Form updates: Combines the CMS-855I and CMS-855R paper applications and discontinues the CMS-855R. Removes physician assistant employer arrangements.

Can you do 855I in pecos?

The Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or The paper CMS-855I enrollment application. Be sure you are using the most current version. NOTE: All reassignment actions should now be reported via the CMS-855I. The CMS-855R (Reassignment of Medicare Benefits) form has been discontinued.

What is the difference between 855s and 855b?

The 855b is used for Diabetic Education and Mass Immunization while the 855s is for Durable Medical Equipment and non-accredited drugs. What is the difference between 855b and 855s? Medicare requires a $50,000 surety bond from an authorized surety company as required in 42 C.F.R. section 424.57(d).

What is an 855I form?

CMS-855I: For reassigning individuals who are new to the Medicare program, or not PECOS enrolled (sections 1, 2, 3, 4B, 13, and 15). CMS-855I: For employed physician assistants (sections 1, 2, 3, 13, and 15) CMS-855R: Individuals reassigning (entire application). CMS-588: EFT mandatory.

What is the CMS-855I used for?

Physicians and non-physician practitioners. All physicians and non-physician practitioners must complete the Medicare Enrollment Application - Physicians and Non-Physician Practitioners (CMS-855I) application in order to initiate the enrollment process and, as applicable, wish to reassign their benefits under 424.80.