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CMS 855A. Form Title. Medicare Enrollment Application - Institutional Providers.
Are you moving, currently receiving benefits or enrolled in Medicare and want to know how to change your address? You can change and update your information anytime, anywhere by logging in to or creating a free my Social Security account.
Paper Enrollment Applications The following forms are routinely submitted with an enrollment application: Electronic Funds Transfer (EFT) Authorization Agreement (Form CMS-588) Medicare Participating Physician or Supplier Agreement (Form CMS-460)
For providers (including physicians and suppliers) who have enrolled in Medicare, to sign a participation agreement (Form CMS-460) is to agree to accept assignment for all covered services that are provided to Medicare patients.
Participating providers accept Medicare and always take assignment. Taking assignment means that the provider accepts Medicares approved amount for health care services as full payment. These providers are required to submit a bill (file a claim) to Medicare for care you receive.
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Log into Internet-based PECOS.Change an Address on a Paper Enrollment Application CMS-855A for Institutional Providers (PDF, 835 KB) CMS-855B for Clinics/Group practices and Certain Other Suppliers (PDF, 833 KB) CMS-855I for Physicians and Non-Physician Practitioners (PDF, 378 KB)
The Centers for Medicare Medicaid Services (CMS) is a Federal agency within the U.S. Department of Health and Human Services. Many CMS program related forms are available in Portable Document Format (pdf).
CENTERS FOR MEDICARE MEDICAID SERVICES. INSTRUCTIONS FOR THE MEDICARE PARTICIPATING PHYSICIAN. AND SUPPLIER AGREEMENT (CMS-460) To sign a participation agreement is to agree to accept assignment for all covered services that you provide to Medicare patients.
This section is completed by the Medicare carrier or A/B MAC. Individual practitioners subject to mandatory assignment are not required to sign a CMS-460. Exception: CMS-460 is needed when practitioners are forming a group or are incorporated.
Participating providers accept Medicare and always take assignment. Taking assignment means that the provider accepts Medicares approved amount for health care services as full payment. These providers are required to submit a bill (file a claim) to Medicare for care you receive.

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