The CMS-855B form is the Medicare Enrollment Application for Clinics, Group Practices, and Other Suppliers, approved through 03/2024 and issued by the Centers for Medicare and Medicaid Services. This application is required for entities enrolling in Medicare for the first time, revalidating enrollment, or updating their Tax Identification Number, legal business name, or practice location.
Clinics, group practices, and other suppliers that are not individual practitioners must use this form. Organizations enrolling for the first time, changing ownership (CHOW), reactivating billing privileges, or making significant enrollment updates submit the application to their Medicare Administrative Contractor (MAC).
Applicants may submit via the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or by mailing a paper application to their MAC. PECOS submissions typically process faster. Both require an accurate National Provider Identifier (NPI), Legal Business Name (LBN), and Tax Identification Number (TIN) that match Medicare records.
Other Medicare enrollment forms include the CMS 855A form for individual physicians, the CMS 855R form for reassignment of benefits, and the CMS 855S form for DMEPOS suppliers.
| Question | Answer |
|---|---|
| Form Name | CMS 855B Form |
| Form Length | 49 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 12 min 15 sec |
| Other names | cms form 855b, cms855b, medicare 855b |
