Our PDF editor makes it straightforward to complete the CMS-855A enrollment application online. Follow these steps to fill out and submit your application without difficulty.
Step 1: Open the CMS-855A Form
Click the orange "Get Form Here" button at the top of this page. The application opens directly in your browser with no software installation required.
Step 2: Enter the National Provider Identifier
Enter your organization's 10-digit NPI number in the National Provider Identifier section. The NPI is required for all Medicare enrollment applications. If your institution has multiple billing locations, each location that bills Medicare separately may require its own NPI entry.
Step 3: Complete the Core Information Sections
Fill in the required information across the main application sections:
- Additional information: Legal organization name, tax ID, and business type.
- Mailing address: The address where Medicare will send your Remittance Advice notices.
- Practice locations: All locations where your institution serves Medicare beneficiaries.
- Managing employees: Individuals with five percent or more ownership interest or managing control.
Step 4: Complete the Billing Number Information
Select your reason for application in the Billing Number Information section. Options include:
- New enrollment in Medicare
- Adding a new practice location
- Reactivating a Medicare enrollment
- Voluntarily terminating Medicare enrollment
- Reporting a change of ownership or control
If you are reporting a change of ownership, submit the application within 30 days for changes requiring prior CMS approval, or within 90 days for other reportable changes.
Step 5: Complete the Authorization and Signature
Enter all required information in the rights and responsibilities fields. The authorized official of your institution, meaning the individual with legal authority to enroll your organization in Medicare, must sign and date the application. An application submitted without this signature will be rejected by your Medicare Administrative Contractor.
Step 6: Review and Finalize
Before finalizing, review your completed application carefully. Confirm all required fields are filled in, all supporting documents are attached, and ownership and managing control information is fully disclosed. When satisfied that the application is complete and accurate, click the "Done" button to export the finalized form.
Step 7: Save and Submit
Make two or three copies of the completed application for your records. You can download the application as a PDF, send it by email, or print it for mailing. Mail the completed application along with all required supporting documents to your assigned Medicare Administrative Contractor.
Tips for a Successful Application
- Consider submitting through PECOS online for faster processing.
- Follow up with your MAC if you have not received confirmation within 60 days.
- Update your enrollment record within 90 days of any reportable changes to your organization.
- Keep copies of all submitted documents for future reference.
Frequently Asked Questions
What is the difference between the CMS 855A and CMS 855B?
The CMS 855B form is used by physician group practices and other Part B suppliers. The CMS 855A is for institutional providers billing Medicare for Part A services, such as hospitals and home health agencies.
Do I need an NPI to complete the CMS 855A?
Yes. All healthcare providers who transmit health information electronically in connection with covered transactions must have an NPI. Your organization's NPI is required to complete the Medicare enrollment application.
How long does Medicare enrollment take after submitting the CMS 855A?
The standard processing time is 60 to 90 days after a complete application is received. Applications missing required information or documentation will be returned, which can add additional weeks to the timeline. Submitting through PECOS typically results in faster processing than the paper method.
