The CMS-855R form is used by individual healthcare practitioners to reassign their Medicare Part B billing rights to an eligible organization. When you file the cms 855r form, the organization can bill Medicare directly for services you provide. The cms 855r form applies to physicians, nurse practitioners, physician assistants, and other Medicare-enrolled practitioners who join a group practice or change their billing arrangement.
File the cms 855r form if you are in one of these situations. You are newly joining a group practice and want that practice to bill Medicare for your services. You are changing the organization that currently receives your Medicare payments. You want to end an existing billing reassignment entirely. In each case, a new cms 855r form submission is required.
Both the practitioner and the receiving organization must be enrolled in Medicare before or at the time of the cms 855r form submission. If either party is not yet enrolled, the Medicare Administrative Contractor (MAC) will reject the application. Active enrollment for both parties is a firm requirement.
The cms 855r form is eight pages and contains several important sections. Section 1 asks why you are filing. You choose one option: Add, Change, or Remove a reassignment. Section 2 captures your personal and professional details. Enter your full legal name, National Provider Identifier (NPI), Social Security Number, and home address. Your information must match your current Medicare enrollment records exactly. Section 3 asks for the receiving organization's name, NPI, and Tax Identification Number (TIN). Section 4 requires effective dates and signatures from both parties. An unsigned cms 855r form will be returned without processing.
You have two ways to submit the cms 855r form to Medicare. The first option is through PECOS, the online Provider Enrollment, Chain, and Ownership System. Log in with your I&A credentials and navigate to the reassignment section. Online submission is faster and allows you to track your application status. The second option is paper submission. Mail the completed cms 855r form to your local MAC. CMS lists all MAC mailing addresses on their website. Your MAC is determined by the state where you practice.
MACs typically process the cms 855r form within 60 days. Online submissions through PECOS are usually faster than paper forms. You will receive a written approval notice with the effective date of the reassignment. Do not change your billing arrangement until you receive this confirmation. Keep billing under your current method during the review period.
Missing NPI numbers or incorrect NPIs are the top reason the cms 855r form gets rejected. Always verify NPI numbers at the NPPES NPI Registry before you submit. Incomplete signatures are another common problem. Both you and an authorized official of the receiving organization must sign before submission. Using an old version of the cms 855r form is also a frequent error. Download the current version directly from the CMS website or use a fillable pdf version. The form revision date appears at the bottom of each page.
Can I reassign my Medicare benefits to more than one organization at a time?
No. The cms 855r form only allows reassignment to one organization at a time. To change the receiving organization, file a new cms 855r form to remove the current reassignment and add the new one.
How long does a reassignment stay active?
Your Medicare reassignment stays active until you file a new cms 855r form to end it. There is no automatic expiration date. You must actively terminate the reassignment when you leave a practice or change employers.
What if my MAC requests additional documentation?
Respond as quickly as possible to any MAC documentation requests. Common requests include copies of your professional license or documentation of your employment relationship with the organization. Delays in responding can slow down processing of your application.
| Question | Answer |
|---|---|
| Form Name | Cms 855R Form |
| Form Length | 8 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 2 min |
| Other names | cms 855r provider enrollment form, cms 855r enrollment application, cms 855r medicare enrollment, 855r provider enrollment form |
