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Click 'Get Form' to open the CMS-855I in our platform's editor.
Begin with Section 1, where you will indicate the reason for submitting the application. Check the appropriate box and complete all applicable sections.
In Section 2, provide your personal identifying information. Ensure that your name, date of birth, and Social Security Number match your official records.
Proceed to Section 3 to report any final adverse legal actions. Fill this section completely as it is crucial for your application.
Complete Section 4 with your business information if applicable. If you have multiple practice locations, ensure each is reported accurately.
Review all sections for accuracy and completeness before signing in Section 15. Use our platform’s tools to easily edit or add any necessary information.
Start filling out your CMS-855I form today on our platform for free!
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.
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.
What is CMS-855R individual reassignment of medicare benefits?
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 Medicare 855I form for?
Use the Medicare Enrollment Application - Physicians and Non-Physician Practitioners (CMS-855I) for individual physicians and practitioners: Enrolling in Medicare for the first time in each state. Reporting changes to previously reported enrollment information. Revalidating their Medicare enrollment record.
What is the difference between 855B and 855I?
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
cms855i
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