Provider Enrollment Packet
CGS's "Provider Enrollment Packet" offers assistance in completing an accurate CMS-855A. The CMS-855A Medicare enrollment application must be completed when enrollment information needs to be added, deleted, or changed. This includes:
- Changing Existing Medicare Information—Currently Enrolled Providers
- Additions, Deletions, and Changes of Address
- Managing/Directing Employee Change
- Authorized/Delegated Official Change
- Transfer of Stock
- Note that in conjunction with any change submitted on the CMS-855A or 588 form, a full CMS-855A may be required if the provider has not submitted an application since implementation of the Provider Enrollment Chain and Ownership System (PECOS) on July 29, 2002
- Initial Enrollment Resulting in Issuance of a Medicare Provider Number
- Home Health Agency Capitalization Requirements
- Voluntary Termination
- Changes of Ownership (old and new owner)
- Acquisitions and Mergers (acquiring and acquired owners)
- Consolidations (consolidating owners and newly created provider)
- Revalidation (contractor requested or voluntary)
- Reactivation of previously deactivated provider number
Access the following:
- CMS-855A
application and instructions
— Available
on the Centers for Medicare & Medicaid Services (CMS) Web site and
can be completed on-line or can be downloaded to complete manually. - Electronic
Funds Transfer (EFT) Authorization Agreement (CMS-588) Form — Allows
Medicare to transfer payments to your facility's financial institution.
Must be completed for new enrollments. For enrolled providers, if not already
receiving EFT, the CMS-588 EFT form must be completed when requesting an
enrollment change. The CMS-588 EFT form must be submitted with the CMS-855A
application. Refer to CGS's Electronic
Funds Transfer (EFT) Web page for additional information.
Additional Resources
- CMS
Provider Enrollment Web site
- CGS Provider Enrollment Frequently Asked Questions provides answers to frequently asked questions about provider enrollment
- The
Basics of Medicare Enrollment for Institutional Providers
- Internet-Based
Provider Enrollment, Chain and Ownership System (PECOS) Contact Information
- How
to Protect Your Identity Using the Provider Enrollment, Chain, and Ownership
System (PECOS)
- Medicare
Learning Network Medlearn Matters Articles provides
articles designed to inform the physician, provider, and supplier community
about the latest changes to the Medicare Program.
- Provider
Enrollment in the Medicare Program
- Announcing
the Release of the Revised CMS-855 Medicare Enrollment Applications
- Medicare
Enrollment for Institutional Providers Brochure provides
an overview of the enrollment process.
- Medicare
Program Integrity Manual, (CMS Pub.100-08), Chapter 10
- Medicare
Program Integrity Manual, (CMS Pub.100-08), Chapter 15
- State
Operations Manual
Updated: 04.24.12
