Cms 855b 2026

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The document is the Medicare Enrollment Application (CMS-855B) for clinics, group practices, and certain suppliers. It outlines the process for enrolling in the Medicare program, including eligibility criteria, required documentation, and instructions for completing the application. The document specifies various supplier types that must use this application, such as ambulance services and independent diagnostic testing facilities. It also details billing number information, necessary supporting documents, and penalties for providing false information. Additionally, it includes sections for identifying ownership interests and managing control information.

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Click ‘Get Form’ to open the CMS 855B application in the editor.
Begin by filling out Section 1, Basic Information. Indicate whether you are a new enrollee, reactivating your enrollment, or changing your Medicare information.
In Section 2, Identifying Information, provide your legal business name and tax identification number. Ensure that all details match IRS records.
Complete Section 3 regarding any final adverse legal actions or convictions. This is crucial for compliance.
Proceed to Section 4 to list your practice locations. Include addresses and ensure they are accurate for Medicare billing purposes.
In Sections 5 and 6, report ownership interests and managing control information accurately to avoid delays in processing.
Finally, review all sections for completeness and accuracy before submitting the application through our platform.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (130 Votes)
2020	4.4 Satisfied (75 Votes)
2011	4.4 Satisfied (336 Votes)

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