Cms 855r 2026

1. Click ‘Get Form’ to open the CMS 855R in the editor.
2. Begin with Section 1, where you must indicate the reason for submitting this application. Check the appropriate box and provide the effective date.
3. In Section 2, enter the organization/group receiving the reassigned benefits. Ensure that the legal business name matches IRS records.
4. Proceed to Section 3 to provide details about the individual practitioner who is reassigning benefits. Fill in all required fields accurately.
5. If applicable, complete Section 4 for primary and secondary practice locations. Indicate whether you are adding, changing, or removing information.
6. In Section 5, designate a contact person if needed. This section is optional but can facilitate communication with your designated MAC.
7. Finally, ensure Sections 6A and/or 6B are signed by both the individual practitioner and an authorized official of the organization/group to validate your application.

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