The CMS 855A form is the Medicare Enrollment Application for Institutional Providers. This application is required for healthcare institutions billing Medicare for Part A services, covering both initial enrollment and updates to existing enrollment records.
The following types of institutions must submit the CMS 855A application to participate in Medicare:
Medicare offers two methods to submit your enrollment application. You can apply through PECOS (Internet-based Provider Enrollment, Chain, and Ownership System), which allows for faster processing. Alternatively, you can complete the paper application and mail it to your Medicare Administrative Contractor (MAC).
Before submitting your application, gather the following items:
The following mistakes are responsible for most application rejections and processing delays:
Reviewing each section carefully before submission significantly reduces the chance of rejection.
After submitting your completed application, a Medicare Administrative Contractor will review it. Depending on your provider type, a state agency or accreditation organization may also conduct a survey. The review process typically takes 60 to 90 days. Once approved, you will receive your Medicare billing number and can begin billing for covered services.
Depending on your provider type, you may need additional enrollment forms. The CMS 855B form is used by physician group practices and other Part B suppliers. The CMS 855R form is used to reassign Medicare benefits to a group practice. DMEPOS suppliers submit the CMS 855S form. Additional Medicare resources are available through our Medicare forms collection.
| Question | Answer |
|---|---|
| Form Name | Cms 855A |
| Form Length | 60 pages |
| Fillable? | Yes |
| Fillable fields | 266 |
| Avg. time to fill out | 34 min 8 sec |
| Other names | 855a mail form, 855a form, cms 855a form, cms information |
